2008 Annual Report

Responsible GrowthRooted in the Community

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Letter from the Chairman of the Board

As I write this letter, we find ourselves in the midst of momentous change andtumultuous economic times. We have witnessed an historic presidential election. Wehave watched the economic distress and recession that is changing the businesslandscape at every turn. In this environment even the long insulated healthcare industryfeels economic stress.

Like you, Anna Jaques Hospital has watched these events and focused on maintaining asteady course through it all. We have tightened our work force, reviewed internalprocesses for efficiencies and increased economies, conducted a thorough fiscal budgetprocess resulting in a lean budget with a realistic profit from operations, and soughtsavings through standardization and the use of a group purchasing organization.

The board’s building committee worked tirelessly in their oversight of two very importantbuilding projects; the emergency department’s new Gerrish Fast Track and the newWorobey MRI center. These two projects were important to patient satisfaction and the

delivery of care, as well as the hospital’s revenue stream. Both weresatisfactorily completed.

Our priority is to keep every person working here employed. Currently,that numbers approximately 1,000 people. We believe that by practicingfiscal restraint while delivering the best patient care possible, we canoperate a hospital that patients will trust and turn to for healthcare,carrying us through these unsettled times.

The Board of Trustees has made priorities of the issues of quality careand patient safety. We convened a board level quality committee thateach month reviews patient satisfaction rates for all departments. The

committee also reviews emergency department wait times, and progress on meetingnational patient safety goals, including treatment of heart attacks, heart failure,pneumonia, and the prevention of surgical site infections. We focus on these areas as we continue to work on making our vision a reality: to rank among the top 10 percent of comparable U.S. hospitals for quality and patient satisfaction by the year 2010.

The Board of Trustees continues its commitment and promise to every patient we serve.We will continue to build a financially stable hospital that delivers the safest, highestquality, most compassionate patient care possible, so that you can receive your healthcare close to home.

Sincerely,

George H. Ellison, Jr. Chairman

“We will continue to build afinancially stable hospital thatdelivers the safest, highestquality, most compassionatepatient care possible, so that you can receive yourhealthcare close to home.”

Letter from the President

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In 2008 we were able to fulfill important commitments to the community and complete a long anticipated construction project. The Gerrish Fast Track, a new addition to ouremergency department, opened its doors. The access road, Wallace Bashaw Jr. Way,officially opened. The Newburyport Medical Center was built and the anchor tenant,Commonwealth Newburyport Cancer Center, moved in.

The community has long requested that we continue to work on making our Emergencydepartment function more smoothly. In November our fast track service for lesscomplicated patients in the ED became a reality. The Gerrish Fast Track opened, namedto recognize a generous gift from the Gerrish Family Foundation. The fast track systemis designed to treat patients with less involved conditions, about 40% of our patients, inless than two hours. During construction, the emergency departmentstaff and physicians continued to deliver a high level of patient care,seeing 32,000 patients and operating the Trauma Center and thePrimary Stroke Service.

The long awaited access road to the hospital opened this fall. Named Wallace Bashaw Jr. Way, the road provides direct access to the hospital and will significantly reduce truck traffic through the small streets in the neighborhood.

One of the important accomplishments this year was the construction of the NewburyportMedical Center, which will hold the area’s first comprehensive cancer care center,Commonwealth Newburyport Cancer Center. The Cancer Center has opened theradiation oncology service and will soon incorporate the hospitals’ chemotherapy infusionsuite. This Cancer Center means that patients will no longer have to travel 25 minutes ormore for radiation therapy and other aspects of their cancer care, including clinical trials.We have high hopes for the success of this center and its ability to serve patients whenthey are most vulnerable and may choose to remain close to home if they can receivefirst-rate care.

Internally, we increased our focus on measurable quality goals. The strategic plan for2010 is for Anna Jaques to rank among the top ten percent of medium sized communityhospitals for quality metrics like patient mortality and complications. The Thomson-Reuters data, a national benchmarking service, suggests that Anna Jaques is very close to if not at that level of quality performance this last six months. This goal will remain acentral value of the hospital, to deliver local care that people locally can measure andhave rock solid confidence in.

Sincerely,

Delia O’ConnorPresident/CEO

“This goal will remain a centralvalue of the hospital, to deliverlocal care that people locally can measure and have rock solid confidence in.”

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Anna Jaques Hospital continues to strive toward providingthe highest quality of care. We have established goals ofbeing in the top 10% of hospitals nationally by 2010 forquality and in the top 10% of hospitals in Massachusetts forpatient satisfaction. As part of this commitment, we havedecided to be as transparent as we can, and are putting ourquality measures on the hospital website for all to see.

Healthcare associated infections have become an area of extraordinary focus in the hospital community, and areincreasingly understood by the public. It is now recognizedthat by instituting appropriate preventive measures certaintypes of infections can be 100% preventable and thereforelives can be saved. These include central line infections(infections from intravenous lines that are placed in a largecentral vein), ventilator associated pneumonia, and sometypes of surgical site infections. Anna Jaques Hospital hashad an excellent record in the recent past. We have not hada ventilator associated pneumonia for over a year, and havenot had a central line infection for over 9 months.

Another of our primary goals is to have clinical outcomesequivalent to the Top 100 US Hospitals as determined by

the Thomson-Reuters Corporation (formerly known as the Solucient Top 100). The two most important qualityoutcomes measures are complication rates and mortalityrates. In both of these areas our performance is either close to, or better than, the benchmark for the top 10% of medium-sized community hospitals across the nation,which is our peer group. The graphs below demonstrateAnna Jaques Hospital’s achievement.

One of the more common hospital rankings that areavailable to the public are the core measures. These arestandardized process improvement measures which, ifimplemented, should lead to improved outcomes. Our goalhere as well, is to be in the top 10% of US hospitals. Wehave some way to go in order to reach this goal, as thegraph below demonstrates. While we have graduallyimproved, so has the rest of the hospital community.

We are proud of the progress we have made towardmeasurable clinical outcomes, and we are committed to achieving our goals as stated, so that our patients can be even more confident that the care we provide meets the highest competitive standard.

Quality Care

HOSPITAL ACQUIRED INFECTIONS – GOAL = 0%

Infection Cases this FY Months since last case

Ventilator Assoc Pneumonia 0 >15

Central Line 0 >9

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AJH Top 10% Medical Community US Average

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AJH Top 10% US Hospitals

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Q2 07-Q1 08Q1 07-Q4 07Q4 06-Q3 07Q3 06-Q2 07Q2 06-Q1 07Q1 06-Q4 06Q4 05-Q3 06Q3 05-Q2 06

AJH Compared to Top 10% of US HospitalsOverall Quality – July 2005 – March 2008

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Inpatient (Higher=Better)

Anna Jaques Hospital Goal

64%ile 80%ile+

This chart shows the extent to whichpatients are satisfied with their inpatientexperience. This includes their satisfactionwith the overall hospital environment anddelivery of care. Anna Jaques Hospitalgoal is 80%ile.

Physician (Higher=Better)

Anna Jaques Hospital Goal

46%ile 70%ile

This chart shows the extent to whichpatients are satisfied with the physicianwho cared for them while in the hospital,the Hospitalist. This rates the patient’ssatisfaction with the respect and courtesyof the Hospitalist, and how well thephysician listened to, and communicatedwith, the patient. Anna Jaques Hospitalgoal is 70%ile.

ED (Higher=Better)

Anna Jaques Hospital Goal

71%ile 80%ile+

This chart shows patient satisfactionwith their experience in the emergencydepartment. It rates length of waitingtime, courtesy and communication ofthe physician and nursing staff. AnnaJaques Hospital goal is 80%ile.

Birth Center (Higher=Better)

Anna Jaques Hospital Goal69%ile 75%ile+

This chart shows patient satisfactionwith the Birth Center. This includesrespect and courtesy, and communi-cation, of the physician and nursingstaff. Anna Jaques Hospital goal is75%ile.

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Nursing (Higher=Better)

Anna Jaques Hospital Goal

56%ile 80%ile+

This chart shows the extent to whichinpatients were satisfied with thenursing staff. This includes patientsatisfaction with the courtesy andrespect shown them by the nurses, how well nurses listened to the patient, and explained things in a way the patient could understand. Anna Jaques Hospital goal is 80%ile.

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Lab Courtesy (Higher=Better)

Anna Jaques Hospital Goal84%ile 90%ile+

This chart shows the extent to whichpatients are satisfied with the courtesyof the staff in the laboratory. AnnaJaques Hospital goal is 90%ile.

Patient Satisfaction

In the area of patient satisfaction, we strive to be in the top 10% of hospitals in Massachusetts. We continue to make slowand steady progress with outstanding results in the areas of the Emergency Department and the Birth Center. We havemade progress in the area of satisfaction with physicians and overall satisfaction with the hospital, but these numbers haverecently slipped somewhat. We are increasing our efforts to raise these scores and to keep them consistently high. Otherareas require ongoing effort, including ambulatory surgery. The graphs below demonstrate our performance in the mostimportant areas. This information is updated regularly on the hospital’s website.

Commonwealth NewburyportCancer Center opened itsradiation oncology suite inDecember, 2008 in theNewburyport Medical Center.Adjacent to the Anna JaquesHospital campus, the CancerCenter is still partially underconstruction as the medicaloncology suite is finished. Onceit is ready for occupancy in thelate spring, the hospital’schemotherapy suite and the oncologists and nursepractitioner will move to the new building and theCommonwealth Newburyport Cancer Center will becomplete, offering full service cancer care.

The Commonwealth Newburyport Cancer Center is led byLanceford Chong, MD. Dr. Chong has built a distinguishedcareer in the treatment of adult cancers while on the seniorstaff at Memorial Sloan-Kettering Cancer Center in NewYork City.

Chong says the mission and vision of the new Cancer Centeris “to care for the whole patient and to have a meaningfulrelationship with them. To care for others is a passion and a privilege.”

Advanced Radiation Technology

The center offers patients diagnostic and therapeuticcancer services with the most advanced technologyavailable for cancer care today, including a linearaccelerator that offers Intensity Modulated RadiationTherapy (IMRT). Provided by Alliance Imaging, the IMRTdelivers radiation therapy with greater precision than everbefore, destroying cancerous cells while preserving thehealthy surrounding tissues. “This technology rivals whatthe top medical institutions offer,” said Dr. Chong. “Wehave not spared anything in order to provide the latestcancer care to the people in this area.”

The expert team led by Dr. Chong in the new radiationtherapy center includes therapists, oncology-certifiednurses, on-site physicist, dosimetrist, and support staff. Itslocation adjacent to the hospital creates convenience andcomfort for patients who may be very ill. Patients will

receive advanced diagnosticimaging at the hospital,including positron emissiontomography (PET), magneticresonance imaging (MRI),and computer tomography(CT) scans. Their coordinatedcancer care will be availablejust one building away. Dr.Chong will provide advancedradiation oncology services,including prostatic seeds,while utilizing CT andCT/PET planning.

The center will also conduct clinical trials of the newestapproaches to cancer treatment under the auspices of theNational Cancer Institute. It is one of only six practicesparticipating in a program to improve community access to clinical trials.

Complete Cancer Care

Paul Spieler, MD, medical director of the oncologyprogram at Anna Jaques Hospital, will run the Anna Jaques Hospital licensed chemotherapy infusion suite that is integrated into the new Cancer Center. He is joinedby Christopher Seidler, MD, a board certified oncologist/hematologist and Beth Goddard, MD, ANRP, OCN, nurse practitioner.

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The new Newburyport Medical Center that houses the CommonwealthNewburyport Cancer Center.

The cancer care team, L to R, Christopher Seidler, MD, Lanceford Chong, MD,Beth Goddard, Nurse Practitioner, and Paul Spieler, MD.

Fast Track/ED

The care in the Fast Track was outstanding.The nurses were very professional andcaring, and took the time to listen. ...I wasreleased in 80 minutes. I’m grateful I live in your area.”

(name withheld for privacy)R.N., Boston Medical Center

Each year, the Emergency Department sees nearly 32,000patients and that number is growing annually. Building aFast Track has been a priority of the hospital for severalyears. It was our response to community requests that we address the problem of long Emergency Departmentwait times, particularly for patients with relativelyuncomplicated conditions.

In the fall of 2008 The Gerrish Family Foundation Fast Trackofficially opened, named for a generous gift by the GerrishFamily. The long-awaited improvement to the EmergencyDepartment added 2500 square feet of Fast Track space withfour treatment rooms, a nurse’s station, a mid-level practitioner’soffice, and waiting room, all well integrated into the main ED.The Gerrish Fast Track sees patients with relatively uncompli-cated conditions that require treatment, but not extensiveevaluations, in a shorter period of time. This will give thehospital the ability to reduce waiting times across the entireEmergency Department.

Our goal is to have all fast track patients seen, treated, andreleased in one hour and twenty minutes. We are makingsteady progress toward that goal.

The Gerrish Fast Track project also included improvementsto the area used for ambulance parking and unloadingpatients. We improved the grading of the lot used by theambulances to access the ED and provided a new canopy

to protect ambulance patients from the weather. Theseimprovements should help the Emergency Medical Servicecrews and the patients. The new ambulance entrance isnamed the Bud and Harriet Gould Ambulance Entrance to recognize the Gould family gift.

The Gerrish Fast Track cost approximately $2.6 million.Approximately $1.0 million was raised through philanthropywith the lead gift given by the Gerrish Family Foundation.

The main Emergency Department provides highly skilledmedical care to the seriously injured. The Level III TraumaCenter and Primary Stroke Center stabilize those criticallyill patients, and if necessary, transport them to hospitals inBoston by the Boston Medflight helicopter service or anadvanced life support ambulance. All of our EmergencyDepartment physicians are board certified in emergencymedicine, and certified in advanced trauma life supportand advanced cardiac life support. All of our EmergencyDepartment registered nurses are certified in traumanursing and critical care.

Seen on the right, the new Gerrish Fast Track addition to the emergency room.

Curt Gerrish, owner of Rochester Electronics, and his wife Patricia Gerrish(center), cut the ribbon at the official opening of The Gerrish FamilyFoundation Fast Track. Seen (L to R), Delia O’Connor, president and CEO, Anna Jaques Hospital, Charlie Cullen, Chairman, AJH CommunityHealth Foundation Board of Trustees, Diane and Chris Gerrish, and Wayne Capolupo, Anna Jaques Hospital Board of Trustees, Chair, Building Committee.

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New Physicians

In 2008 we continued building and strengthening ourmedical staff. The hospital serves a primary and secondaryservice area with an estimated population of 165,400*people. It is an area of projected high growth over the nexttwo decades. Conservative estimates indicate that sometowns in the hospital’s service territory will grow by asmuch as 21% by the year 2030**. The hospital is planningfor this growth, recruiting the highly skilled, experiencedmedical staff that will be needed to serve the area’sexpanded healthcare needs.

As the Baby Boomers move into their 60s and beyond, the over-55 population in the hospital’s service territory isprojected to increase 75%, until one in three residents is 55 or older.** This creates additional demand for internalmedicine and family practice physicians. In 2008 werecruited Kevin Delahanty, MD to join Coastal Medical

Associates in Salisbury as an internal medicine practitioner.Linda Hindle, DO joined Cornerstone Family Practice inRowley, and Amy Rodgers, DO joined NewburyportMedical Associates in Newburyport as family practitioners.

In 2008 we recruited new providers for the Women’s HealthCare practice. Two midwives, Jessica Lewis, MSN, CNM,and Susan Martinson-Zuercher, RN, MSN, CNM joinedWomen’s Health Care. The practice now has three boardcertified nurse-midwives with Masters level midwiferytraining. The midwives deliver healthcare to women fromtheir teen years through menopause and deliver more than 200 babies each year.

Christine DiLeo, DO joined the Women’s Health Careteam as an OB/GYN. The practice now offers sevenOB/GYN physicians to serve patients across the region,with offices in Newburyport and Haverhill.

Jessica Lewis, CNM, MSN Midwife with Women’s Health Care

Susan Martinson-Zuercher, CNM, MSN, RN, Midwife withWomen’s Health Care

Christine DiLeo, DOWomen’s Health Care

Kevin C. Delahanty, MDCoastal Medical Associates

Linda Hindle, DOCornerstone Family Practice

Amy Rodgers, DONewburyport MedicalAssociates

*2000 census numbers** Metropolitan Area Planning Council

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Surgical Services

Anna Jaques Hospital is implementing a surgical safety checklist developed by the World Health Organization toreduce surgical complications. Thechecklist is designed to promoteteamwork, an understanding of oneanother’s roles, and the details of thepatient’s status, in order to ensure thatno clinical steps are missed before,during or after surgery.

The checklist includes items importantto pre-operative preparation, operatingroom procedure, and post surgicalrecovery of the patient. Questions areasked and prepared for, in order toprevent a bad outcome that might occurif the issues were not addressed.

“Is the patient likely to need blood?”

“Does the patient have IV lines for blood transfusion, if needed?”

“Does the patient have a known allergy?”

“Is all essential imaging available (x-ray, MRI, CT scans etc) and correctly identified as for this patient?”

“Are there specific concerns for pain management orrespiratory issues during recovery?”

In the pre-op room each patient verifies with staff, theprocedure and site of surgery. After the surgery is complete,the surgical team verbally reviews key concerns for thepatient’s recovery, including pain management andrespiratory issues.

Implementing this surgical safety checklist system, and publicly reporting it, is part of our commitment totransparency and communicating how we are improving patient safety.

In addition, in 2008 the hospital purchased equipment andimplemented new surgical safety processes as part of ourefforts to reduce the rate of surgical site infection further,which is already below national benchmarks. Additionalsurgical kits were purchased to ensure that every surgeonhas ready access to instrumentation.

Patient Care and Safety Improvements:

• For selected patients with no predisposing medical

conditions, a pre-admission health screening is

conducted by phone to increase patient convenience.

• Protocols are in place to help ensure the first

operating room case of the day starts on time.

• Patient safety is improved when anesthesia physicians

provide new written guidelines and patient questions

for the phone screening.

• Increasing the quality of patient care is one of the

reasons behind a new survey of surgeons on

instrumentation in the operating room. The survey

collects their feedback on the condition of equipment

to ensure it meets their needs, is in optimal working

condition, and that any needed changes are made.

Members of our surgical services team.

“The checklist increases communication amongoperating team members to make sure that allsteps that can possibly be taken to avoid a badoutcome have been taken.”

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Nursing

At Anna Jaques Hospital, Registered Nurses play a pivotalrole in delivering high quality patient centered care. Thenurse is a coordinator and frontline provider of compassionatepatient care, a patient advocate, communicator, collaborator,and patient/family educator. Nearly half of the nurses atAnna Jaques have worked at the hospital over ten years.The hospital considers them dedicated professionals whostrive to achieve excellence in professional practice and totreat the patients in a caring, personal way. They exemplifythe theme of this year’s annual report, “Rooted in theCommunity” as they care for friends and neighbors and, in some instances, generations of the same family.

As part of the delivery of patient care, each departmentfocuses on patient satisfaction. After discharge, randomlyselected patients receive a Press Ganey patient satisfactionsurvey giving them the opportunity to tell us about theirexperience at Anna Jaques. In the last measured quarter,October through December of 2008, the patient satisfactionscores for nursing improved dramatically. Nursing in theemergency department finished in the 71st percentile,telemetry unit nursing finished in the 80th percentile, andnursing in the Birth Center scored in the 70th percentile.The overall inpatient satisfaction rate with nurses ranked inthe 56th percentile, up from a previous ranking in the 44thpercentile. The patient satisfaction rate with nursing in theambulatory department was in the 60th percentile, a markedincrease from the previous rank in the 26th percentile.*

Our goal is to get all nursing percentile scores to the 90th percentile.

In 2008, more than 70 staff members, clinical and non-clinical, received advanced certifications. This is essentialfor personal professional growth and adding the latest skillsto their experience. Each nurse must also complete theAnnual Review of Knowledge, a highly detailed andcomprehensive review of nursing practice competencies.

Individually, the pursuit of education improves the qualityof patient care as nurses interact with patients. Cumulatively,the pursuit of education creates highly skilled teams incritical specialty care departments. All of the emergencydepartment nurses at Anna Jaques are certified in traumanursing and critical care. All of the wound center nurses inthe Anna Jaques Wound Healing & Hyperbaric Center arecertified wound specialists.

The hospital supports the pursuit of higher education andclinical achievement. In 2008 the annual nursing scholarshipswere awarded to four staff members who are pursuinghigher education in the field of nursing. The $1,000scholarships are sponsored by the hospital, the LowerMerrimack Valley Physician Hospital Organization, theAnna Jaques Hospital Community Health Foundation, the Medical Staff, and the AJH Nursing Division.

* A percentile shows the percentage of scores falling at or below a givenscore. For example, the 80th percentile rank means that Anna JaquesHospital scored higher than 80 percent of the Massachusetts hospitals in the Press Ganey measured group.

The CCSU team accepts the Press Ganey Achievement Award.

“The nursing staff at AJH is dedicatedand skilled. ...The staff on the medical/surgical floors deserves recognition fortheir constant attention to my needsand the needs of my visitors.”

(name withheld for privacy)RN, Massachusetts General Hospital

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Patient Volume & Statistics

KEY STATISTICS 2007 ACTUAL 2008 ACTUAL CHANGE % CHANGE

Admissions 7,636 7,580 (56) -0.7%

Emergency Room Visits 31,042 31,106 64 0%

Surgical Services

Inpatient 831 914 83 10%

Outpatient 4,605 4,790 185 4%

Total Surgical 5,436 5,704 268 14%

Oncology Clinic 2,886 4,226 1,340 46%

Laboratory (Outpatient) 362,005 401,140 39,135 11%

Pain Clinic 1,137 1,198 61 5%

Radiology-X-Ray (Outpatient) 31,872 35,025 31,153 10%

Radiology-Mammogram (Outpatient) 11,170 13,997 2,827 25%

Radiology-MRI (Outpatient) 2,935 3,771 836 28%

PT, OT & Speech (Outpatient) 58,437 71,299 12,862 22%

ICDs (Implantable Cardiac Defibrillator) 13 45 32 246%

Patient volume from October 1 through September 30, 2008.

Part of the hospital’s effort to improve patient satisfactionand care, as well as meet the needs of the medical staff, led to the expansion of the Hospitalist program to includean intensivist. Hospitalists are inpatient medical specialistswith expertise and experience in the practice of hospitalmedicine, who work closely with the ICU staff andrespiratory therapy. An intensivist is a physician withadvanced critical care training who specializes in treatingthe most seriously ill or injured patients.

Christopher Harris, MD is a hospitalist who also functionsas the intensivist who sees patients in the Anna Jaquescritical care unit. Studies have shown that patients whosecare is managed by an intensivist recover more quickly andachieve greater clinical outcomes overall. The intensivistcoordinates the patient’s care plan with nursing and others,and rounds daily with ICU staff, all of which results in

increased quality of patient care. Documented benefits in national reviews include:

• Reduced length of stay in the critical care unit

• Fewer clinical and procedural complications

• Improved patient and staff satisfaction

• Improved morbidity and mortality

The Intensivist Program

The Hospitalist Team: Reza Sharafi, MD, Christopher F. Harris, MD, Intensivist,Aimee J. Hromadka, MD, H. Thompson Mann, MD, Suzanne J. Abkowitz, MD,and Hossam M. Yassin, MD

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eSolutions for Patient Safety

Patient safety is a focus at every point in the delivery ofpatient care at Anna Jaques Hospital. We measure ourprogress against the National Patient Safety Goals of TheJoint Commission, (the organization that accredits andcertifies more than 15,000 health care organizations andprograms in the United States), and other nationalstandards. Compliance with national patient safety goals is a critical part of the hospital’s ongoing Joint Commissionaccreditation. It includes issues such as medication use,infection control, surgery and anesthesia, and effectivecommunication between caregivers for the accuratetransfer of patient information.

This year the hospital implemented a system of electronicprograms specifically designed to increase patient safetyand reduce medical errors.

Online Nursing Documentation

As a first step, the hospital implemented the online nursingdocumentation (NUR) system in the spring of 2007. NUR allows nurses to admit patients and conduct patientassessments at bedside, thereby improving documentationand patient care. An interdisciplinary team worked formore than a year to prepare for the NUR rollout and thencontinued to work together to add features during 2008.

The electronic system allows real time documentation ofcritical patient information, from admission to the nurse’sshift assessment of each patient’s status. Carts with wirelesslaptop computers are wheeled into patient rooms and thecollection of medical information takes place at bedside.The benefit of NUR is an increase in the quality of patient care:

• Nurses no longer have to leave the patient’s bedside to make notes or gather information.

• While at bedside, nurses can access the patient’s historyand information on medications, lab tests, physicianorders, patient care plan, test results, and onlineresources for additional information on diagnosis,medications etc.

• Access to patient information is improved for nurses,physicians and other clinicians. Physicians are able toaccess this patient information, without delay, from their homes or offices.

Electronic Medication Administration Record

The second system the hospital implemented was theelectronic medication administration record (EMAR). This system should reduce medical errors by moving to a paperless environment, one where a standard medicalvocabulary is used, errors that might be caused by illegiblehandwriting are reduced, and error checking can beconducted with order entry for medications and tests. Inaddition, the latest test results, allergies, and medicationorders are immediately available through the patient profileto alert the caregiver to any potential problems prior tomedication administration.

Bedside Medication Verification

The third part of the electronic system implemented thisyear was the electronic bedside medication verification(BMV) program, launched on the medical/surgical floors.

BMV allows caregivers to scan bar codes on patient wrist-bands and medications to correctly identify the patient andthe appropriate medication. (Medications are identified byNDC numbers or the appropriate prescription numbergenerated by the pharmacy.)

Bedside verification processes the data contributing to safe administration by ensuring the “Five Rights” of safemedication administration: Right Patient, Right Medication,Right Dosage, Right Route, and Right Time. This systemshould increase patient safety, increase the level of detailedinformation available to physicians, and assist the hospitalin its goals to meet national patient care standards. A multi-disciplinary team worked for more than nine months toprepare for the implementation of BMV.

The Recycling Program - Going Green

As a responsible corporate citizen, Anna Jaques Hospital isdoing its part in the community wide and nationwide effortto “Go Green”. We have initiated recycling programs withthe goal of significantly reducing our contributions to thewaste stream and saving $10,000 a year. With the supportof the Massachusetts Department of EnvironmentalProtection, the hospital signed an agreement with a vendorto assist us with the recycling program at the hospital. Weare now recycling paper, cardboard (our biggest contributionto the waste stream), cans and bottles.

Retrofitting for Energy Efficiency

Anna Jaques Hospital is an older facility, built in differenteras, and is about 30% less energy efficient than othersimilar facilities, according to recent studies the hospitalhas contracted for. We are trying to become more energyefficient in every way we can, as rapidly as we can afford tomake the infrastructure investments. We have replaced theballasts in hospital lighting to make lighting more energyefficient, for example. All the single pane windows in the1973 section of the hospital (the Rawson Avenue end of the building) have been changed to more energy efficient,thermal casement style windows.

This year we replaced a cooling tower, refurbished a majorair handling system that was 35 years old, and replaced a 28 year-old roof top chiller with a more efficient andslightly larger capacity unit.

Over the next five years we will replace items in ourinfrastructure and purchase large pieces of energy efficientequipment such as boilers. The boilers are 30 years old andvery inefficient. As part of the master facility plan we arelooking at building a new, more efficient power plant. In a recent meeting with an energy consultant we discussedseveral possible options including co-generation, photovoltaic(solar) power, and wind power that is generated by small 6 to8 feet high mechanisms installed at building scale. We don’tknow which will work but the opportunities exist to reduceour energy consumption in a meaningful way and seekcreative, viable alternatives to supplying our energy needs.

Green Aesthetics

As the new Worobey MRI and Gerrish Fast Track additionsto the hospital were built, we were cognizant of the need to

provide acoustical and visual buffers for the neighborhood.We used native plantings to provide a buffer around theambulance entrance to the emergency department and in front of the Worobey MRI. These plantings will takesome time to grow, but they are native to this area and willprovide a pleasing “fence” along the street. An acousticalfence surrounds the cooling fans of the MRI and reducesthe noise generated by them. Noise levels were measuredto ensure we remain well within the regulated decibellevels for the neighborhood.

Infrastructure / Improvements

This year Anna Jaques installed a fixed MRI (MagneticResonance Imaging) site at the hospital, adjacent to theradiology department. The fixed site creates a comfortablewaiting room and changing area for patients, andeliminates the need for the mobile MRI on a van. Thecenter is named the Dennis John Worobey and DennisJoseph “D.J.” Worobey MRI Center, in recognition of alead philanthropic gift by Denise Worobey. The WorobeyMRI center brings the latest Siemens Total Imaging MRItechnology to the hospital and its patients. The technologyoffers a whole body MRI imaging capability, breast MRI,and shorter scan times for the patient.

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The New Worobey MRI Center

Denise Worobey, center, accompanied by family members, cuts the ribbon at theopening of The Dennis John and Dennis Joseph “D.J.” Worobey MRI Center. Seen(far left) with Denise are George Ellison, Chairman, AJH Board of Trustees, DeliaO’Connor, President and CEO, and (far right) Charlie Cullen, Chairman, AJHCommunity Health Foundation Board of Trustees.

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Hospital Awards

National accrediting organizations tell us how we are doing as a hospital, and rate the performance of specificdepartments. This year the hospital received severalnational accreditations, awarded only after rigorousexamination of hospital practices.

Non-Invasive Vascular Laboratory

The hospital’s Non-Invasive VascularLaboratory wasaccredited by theIntersocietalCommission for the Accreditation of VascularLaboratories(ICAVL). Thisrecognizes itscommitment to

providing a high level of patient care and non-invasivequality testing for the diagnosis of life-threatening vasculardisease. During the accreditation process, every aspect ofthe laboratory’s daily operations and its impact on thequality of health care provided to patients was assessed andreviewed. Anna Jaques Hospital’s Non-Invasive VascularLaboratory is one of a select number of vascular laboratoriesin the United States, Canada, and Puerto Rico to meet orexceed the ICAVL standards for noninvasive vascular testing.

Respiratory

For the second year in a row, theAmerican Associationfor Respiratory Care awarded thehospital its QualityRespiratory CareRecognition, as aresult of the qualityof care and level of skill in the AJH

respiratory care department. Only 15% of the hospitals in the United States have received this recognition.

The Anna Jaques respiratory care team continues toimprove outcomes for critically ill, ventilated patients byconsistently implementing “a bundle” of interventions that are known to reduce many problems associated withpatients on mechanical ventilation. Currently the hospital is well below the national average in ventilator acquiredpneumonia with no cases during the last year. AJH progressis measured against national Institute for HealthcareImprovement (IHI) standards, part of the campaign toachieve improved, safe outcomes for patients in the ICU.

Wound Healing & Hyperbaric Center

The Wound Healing& Hyperbaric Centerat Anna Jaques is thefirst and only suchcenter to receive fullaccreditation from the Undersea andHyperbaric MedicalSociety (UHMS). The accreditationindicates the highestindustry standardsand best practices inhyperbaric treatment.

The UHMS rigorous accreditation process took over two and one half years.

The Joint Commission

The hospital is accredited by The Joint Commission, anorganization that surveys and rates the performance ofhospitals at least every three years. The hospital receivedpraise during The Joint Commission’s unannounced,triennial, three day survey this year. In their exit interviewthey said “You have wonderful people doing great thingshere. Dedicated, good employees are one of your strengths.You have a lot to be proud of.”

Vascular Lab Technical Director Derek Butlerwith the technology that helps diagnosePeripheral and Abdominal Vascular disease.

Representatives of the respiratory team atAnna Jaques.

Wound center patient John Kneeland, healedin the hyperbaric chamber, and his nurseDianne Desmarais-Tetreault, LPN, CHT, SD.

Anna Jaques Community Health Foundation

A surgical team using one of the new laparoscopic cholecystectomykits, which was purchased with funds made possible by the GerrishFamily Foundation. The four new kits purchased provide surgicalinstruments to support minimally invasive procedures, such asremoving a gallbladder laparoscopically.

A new anesthesia machine was recentlypurchased with the proceeds raised at our2008 golf outing.

Three new procedure carts were purchased with thegenerous support of Kim Williams (hospital trustee) and Trevor Miller of Newbury. These carts arestrategically placed on the medical surgical units and are used to standardize the protocol andprocedures for all invasive procedures done at the bedside.

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In fiscal year 2008, the Anna Jaques Community HealthFoundation celebrated another successful year ofphilanthropic support for the hospital with the strongleadership of board chair Charlie Cullen and theFoundation’s Board of Trustees. Over $1.4 million was raised during FY08 to support important initiatives andcapital projects undertaken by the hospital.

It was also a year of strong support and collaboration fromthe community. Individuals, businesses, corporations, andlocal foundations gave generously to the hospital, allowingus to successfully complete several key initiatives.

• The Gerrish Family Foundation Fast Track in thehospital’s Emergency Department opened in November.More than $1.1 million was raised to support the project.

• The Foundation’s three annual fundraising eventsgarnered significant philanthropic support of key projectsand initiatives.

:: The Safari Beach Party raised more then $68,000 insupport of capital purchases for surgical services.

:: The Fore Your Health Golf Outing had its mostsuccessful year ever, raising more than $105,000 tosupport capital needs in the Anesthesia Department.

:: The annual Wine Tasting also celebrated its mostsuccessful year, raising more than $35,000 in supportof the Vascular Ultrasound Department.

• Significant leadership gifts received in 2008 will help thehospital continue some of its key initiatives in 2009. Giftsreceived from the Edward S. and Winifred G. MoseleyFoundation are supporting much needed renovations inthe Birth Center.

• Special gifts from James and Christine Zampell, theNewburyport Society for the Relief of Aged Women, and the AJH Aid Association will help purchase newpatient beds and furniture.

The Community Health Foundation will continue to build on this solid philanthropic support as we explore the possibility of a future capital campaign. The campaignwould fund the goals set forth in the hospital’s strategic andmaster facility plans.

Philanthropy made possible the hospital’s founding 125years ago, and continues to be at the core of who and whatwe are. The charitable investments being made now and inthe future will help to fortify Anna Jaques Hospital as itserves the community in the decades to come.

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Community Outreach

Healthy Ways Maze

Twelve students from Newburyport High School werehonored by the hospital for their volunteer work as YouthLeaders implementing the hospital’s newest anti-obesityprogram. The Youth Leaders were educated and trained inthe AJH “Healthy Ways Maze and Old Fashioned Games”program, the benefits of physical activity, and the role itplays in a healthy and balanced lifestyle. Once trained, they traveled to elementary schools twice a week teachingstudents how to play the games and be more active duringrecess. The hospital provides each school with a free plastictub filled with materials and instructions for an obstaclecourse and old fashioned games.

Pre-natal health education in Haverhill

The hospital launched a public education campaign inHaverhill on the importance of pre-natal health. The sixweek campaign was supported by business partners thatincluded Market Basket, Choice Gym, Custom BuiltPersonal Training, Merrimack Valley Federal Credit Union,and Rite Aid Pharmacy. 56,000 flyers were distributed toMarket Basket shoppers and oversized posters lined theproduce and dairy aisles. Rite Aid presented pre-natalhealth cards seen by 200 to 300 shoppers daily. The creditunion placed posters in three branches and information inChoice Fitness was seen by 1,000 people daily. The campaignwas supported by mass transit advertising for the Women’sHealth Care practice that included MVRTA public transitbuses and train platforms.

Amesbury Days Teddy Bear Clinic

Children brought their Teddy Bear orfavorite stuffed animal for a mock-wellness exam. Children received glow-in-the-dark wrist bracelets with the AnnaJaques logo. The hospital has beenasked to make a repeat appearancenext year.

Headstart Program

Nearly 200 children and familiesattended the Haverhill Head StartFair and Health Screening last fall.The hospital presented its Teddy Bearclinic for children. Parents receivedan immunization and screening chartand information on hospital services.

Senior Walking Club and Dinner

The hospital provided 125 pedometers anda wall tracking map to the senior walkinggroup at the Salisbury Hilton Senior Center.The group reports that even some 90 yearold members are walking around the centerand their homes, tracking their steps. Inaddition, once a month the hospital offers asenior dinner with a clinical speaker, andevery night of the week offers to seniorsreduced price dinners in the cafeteria.

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Anna Jaques Hospital continues to branch into new communities with the development of health and wellness programs forstudents, families, and senior citizens. The core of the hospital’s community outreach is providing programs that help schoolsfulfill their wellness curricula. In 2008 these programs included the “How Far Can You Go?” pedometer program, theBackpack program of health information written for 6,200 school age children, the Healthy Ways Maze & Old FashionedGames program, and small sponsorships of local athletic programs and community leagues.

Newburyport Mother’s Club Free Movie Day

136 members of the NewburyportMothers Club attended a free privatescreening of the Pixar “G” rated movieWall-e. A mini-obstacle course was setup in the lobby for the children, parentsreceived information on AJH services.The event was a collaborative effortbetween The Provident Bank and Anna Jaques Hospital.

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Volunteers

Volunteers are an importantresource for Anna JaquesHospital. Each year a variety ofcommunity members givethousands of hours in volunteertime to the hospital. They workin widely diverse roles fromstaffing the gift shop andinformation desk to deliveringmeals, mail, and flowers to ourpatients. Volunteers support ourpatient transport staff, visitpatients and assist hospitaldepartments with clericalprojects. Volunteer knittersdonate their time creating hatsfor newborns, while others knit blankets and hats for cancer patients.

The volunteers who staff the hospital gift shop have helpedto make it one of the frequently visited boutique shops inNewburyport. Each year the gift shop sells thousands ofdollars of merchandise, with sales that outpace nationaltrends, and the proceeds are donated to the hospital.

The Anna Jaques Hospital Aid Association marked it’s 120th anniversary in 2008. Founded in 1888, the group hasprovided the hospital with countless hours of volunteerismand philanthropic support.

In the past year the members of the Aid Association werebusy organizing bake sales, coordinating raffles, planning the annual Great Chef’s night, showcasing local artists in the hospital’s main hallway and, of course, volunteering in the gift shop. These activities and many more helped the

Aid Association raise $70,000. Their gift in 2008 benefitedthe following departments and/or projects: $20,000 for aninfusion chair in the new AJH chemotherapy infusion suite:$23,000 for ventilators to be used by ICU patients; $2,000 for the case management emergency fund; and $25,000 toprovide new furniture for one patient room.

We continue to be grateful to all the past and presentmembers of the Aid Association for their dedication andsupport of Anna Jaques Hospital.

As one of the hospital’s volunteers says: “Working with and being around wonderful people from all generationsand giving back to the community have definitely improvedmy way of life. A wonderful situation is available to you ifyou just reach out and lose yourself in service.”

Anna Jaques Hospital Aid Association

Celebrating 120 Years of Philanthropy and Community Service

Volunteers stand in front of the AJH Gift Shop with manager Sue Dixon inside (L).

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Expe

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Board of Trustees

Back row, left to right: Peter A. Hartmann, MD, Secretary, Wayne P. Capolupo, Board Member, Chair, Building Committee, David J. LaFlamme, BoardMember, Chair, Finance Committee, Michele T. Sasmor, MD, President, Medical Staff, George H. Ellison, Jr., Chairman, Byron J. Matthews, Board Member,Thomas G. Ambrosi, Vice Chairman, Jan Morse, Board Member, Mark Welch, Board Member, Lisa L. Mead, Board Member, Frank G. Cousins, Jr., Member-at-Large

Front row, seated, left to right: Stephen P. Beaudoin, MD, Board Member, Ann Lagasse, Board Member, Leslie J. Sebba, MD, Chief Medical Officer, Board Member, Jan Marcus, President, Aid Association, Kim Williams, Board Member, Chair Quality Committee, Charles R. Cullen, Chairman, Foundation,Delia O’Connor, President/CEO

Not present in photo: The Honorable Christopher J. Armstrong, Board Member

EXECUTIVE COMMITTEEGeorge H. Ellison, Jr., ChairmanThomas G. Ambrosi, Vice ChairmanPeter A. Hartmann, MD, SecretaryMichele T. Sasmor, MD, President Medical StaffLeslie J. Sebba, MD, Chief Medical OfficerDavid J. LaFlamme, Finance CommitteeKim Williams, Board Quality CommitteeWayne P. Capolupo, Building CommitteeSheriff Frank G. Cousins, Jr., Member-at-Large

BOARD MEMBERSStephen P. Beaudoin, MDCharles R. Cullen, Chairman, FoundationLisa L. MeadJan MorseMark F. WelchChristopher J. ArmstrongAnn LagasseByron J. MatthewsJan Marcus, President, Aid Association

TRUSTEE EMERITUSWilliam L. Plante, Jr.Josiah H. WelchDavid S. Outhouse

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Medical Staff

The Medical Department Chairs and Medical Staff Officers at Anna Jaques Hospital serve as leadership for theapproximately 350 Medical Staff and Allied Health Professionals credentialed at the hospital. They provide clinical andtechnical expertise to clinicians in their respective departments and provide oversight to ensure compliance with regulatoryagencies. Their leadership helps the hospital to plan strategically for future technical advancements in the field.

PRESIDENTMichele Sasmor, MD

VICE PRESIDENTGlen Crawford, MD

SECRETARY/TREASURERGuy Navarra, MD

DEPARTMENT OF EMERGENCY MEDICINEJoe Hull, MD, Department ChiefRon Freid, DO, Assistant Chief

DEPARTMENT OF ANESTHESIASteven Parker, MD, Department ChiefRobert Kirkman, MD, Assistant Chief

DEPARTMENT OF MEDICINEGuy Navarra, MD, Department ChiefH. Thompson Mann, MD, Assistant Chief

DEPARTMENT OF OBSTETRICS & GYNECOLOGYJane Kerr, MD, Department ChiefCeleste Royce, MD, Assistant Chief

DEPARTMENT OF PATHOLOGYHeather Crowley, MD, Department ChiefPhilip A. Tisdall, Assistant Chief

DEPARTMENT OF PEDIATRICSAlice Merkrebs, MD, Department ChiefTammy Bottner, MD, Assistant Chief

DEPARTMENT OF PSYCHIATRYDavid Sorenson, MD, Interim Department ChiefAssistant Chief, vacant

DEPARTMENT OF RADIOLOGYRichard Rosin, MD, Department ChiefThomas Riley, MD, Assistant Chief

DEPARTMENT OF SURGERYKenneth Glazier, MD, ChiefDavid Swierzewski, MD, Assistant Chief

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Statement of Operations

Year Ended September 302008 2007

Operating revenuesNet patient service revenue $ 96,429,763 $ 91,197,942Other operating revenue 2,976,985 3,598,682Net assets released from restriction used for operations 132,652 103,083

_____________________________

Total operating revenues 99,539,400 94,899,707

Operating expensesSalaries and wages 44,864,850 42,860,564 Employee benefits 11,180,486 10,620,703Supplies and other 33,978,730 31,638,957Provision for uncollectible accounts 4,192,511 4,012,137Depreciation and amortization 3,737,054 3,596,284Interest expense 850,517 663,981

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Total operating expenses 98,804,148 93,392,626_____________________________

Gain (loss) from operations $ 735,252 $ 1,507,081__________________________________________________________

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Year Ended September 302008 2007

AssetsCurrent Assets:

Cash and cash equivalents $ 6,912,324 $ 5,256,087Patient accounts receivable, less allowance

for uncollectible accounts of $2,502,739in 2008 and $2,171,173 in 2007 13,085,522 11,704,577

Materials and supplies 1,166,722 1,042,953 Assets whose use is limited-current portion 1,154,255 1,408,143 Prepaid expenses and other current assets 591,271 1,156,135

______________________________Total current assets 22,910,094 20,567,895

Assets whose use is limited or restricted:Investments:

Held by trustee under debt agreements 63,774 4,153,086 Beneficial interest in perpetual trusts 3,055,445 3,847,525Board designated funds 8,816,812 8,685,767Donor-restricted funds 7,477,710 10,015,982Pledges receivable 190,242 133,821

______________________________Total assets whose use is limited or restricted 19,603,983 26,836,181

Property, plant and equipment, net 22,588,254 21,713,081

Other assets 3,276,569 3,019,630______________________________Total assets $ 68,378,900 $ 72,136,787____________________________________________________________

Liabilities and net assetsCurrent liabilities:

Current portion of long-term debt $ 774,406 $ 1,511,427Accounts payable and accrued liabilities 10,380,975 9,839,321Due to third-party payers, net 754,903 968,021

______________________________Total current liabilities 11,910,284 12,318,769

Long-term debt, less current portion 10,759,901 11,574,242Other liabilities 6,208,589 5,864,253

______________________________Total liabilities 28,878,774 29,757,264

Net assets: Unrestricted 26,827,812 27,309,172Temporarily restricted 7,727,606 9,333,563Permanently restricted 4,944,708 5,736,788______________________________

Total net assets 39,500,126 42,379,523______________________________

Total liabilities and net assets $ 68,378,900 $ 72,136,787____________________________________________________________

Consolidated Balance Sheets

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Anna Jaques Hospital Management

Delia O’ConnorPresident & CEO

Mark GoldsteinVice PresidentChief Financial Officer

Leslie J. Sebba, MDChief Medical Officer

Richard Maki, RN, BA, MHSAVice PresidentChief Nursing Officer

Stephen F. SalvoVice PresidentHuman Resources

Deborah ChiaravallotiVice PresidentPublic Relations & Marketing

Richard J. Napolitano, Jr.Vice President DevelopmentExecutive DirectorAnna Jaques Community Health Foundation

James A. BorekDirector Diagnostic Imaging

Robert R. Buchanan, Jr.Chief Information Officer

Jeanine Cunningham, RNDirector Surgical Services

Andrew LobbDirector Wound Healing &Hyperbaric Medicine Center

Richard DoolanDirector Materials Management

Phillip G. Drews, BS, RRTDirector Cardiopulmary Care Rehab Services/Diagnostics

David FowlerSenior Director Support Services

Isaac GarciaDirector Environmental Services

Jeffrey M. GwinnDirector Pharmacy

Thora HealyDirector Medical Staff Office

Mark J. KelleyDirector Food & Nutrition

Robert J. KelleyDirector Finance

Paula LaneDirector Education & Professional Practice

Kathleen M. LeBlanc, RNDirector Medical/Surgical Services

Karin D. Leppanen, RN, MS, OCNDirector Outpatient Clinics & Nursing Supervisors

Mary E. Lord, RNC, BSDirector Psychiatric Services

Rachael McKenzie, RNDirector Case Management

Sandra LevinDirector Quality, Risk, & Patient Safety

Maria V. Palumbo, RHIADirector Health InformationManagement

Patricia J. Powers, RN, COHNDirector Occupational Health Services

Karen D. Sindoni-Westhaver, RNDirector Critical Care, CCSU

Joseph SoldanoDirector Financial Planning

Hilary J. SondikDirector Patient Financial Services

Charlene A. Torrisi, RNC, MSNDirector Maternal Child Services

James WalkerDirector Laboratory

Diane E. WigmoreDirector Emergency Department

Elizabeth M. WrightDirector Human Resources

Emily M. WrightDirector Volunteer Services

“From the minute I arrived…I knew I was incompetent, caring hands. My husband had surgeryin a Boston hospital last year and was just anumber. At AJH I felt like family. It was a verypositive experience and I will never forget how I was cared for at Anna Jaques.”

(name withheld for privacy)

25 Highland Avenue Newburyport, MA 01950

978-463-1175 • www.ajh.org

Cert no. SW-COC-002376