Ira Stein, M.D.

Dr. Ira Stein is one of only two Pediatric Otolaryngology sub-specialists in the North Palm Beach County area. On a daily basis, Dr. Stein exhibits strength, support and commitment to his young patients, their families and our community.

Dr. Stein has been Chief of Staff at Palms West Hospital for the last two years and prior to that he was our Vice Chief of Staff and our Credentials Chairman. He oversees the Medical Staff and works with the Administrative Team to assist with the growth of the Hospital including the dedication of The Children’s Hospital at Palms West. Dr. Stein has also chaired the Continuing Medical Education Committee and provided numerous lectures to our residents to further their education.

Dr. Stein is an integral part of our community in that he attends to emergency room patients even when not scheduled to provide emergency room call coverage. He sacrifices time with his own family to care for the children of our community. Shannon Fox-Levine, M.D., local pediatrician, describes Dr. Stein as a “physician who has a wonderful bedside manner. Parents feel like he cares about the decision that he includes them in as far as surgery vs. wait and watch approach. He always makes room to see patients we are concerned about in the office, even the same day to ease our minds, as well as the parents.”

Dr. Stein is also a provider for Children’s Medical Services, which is a program that provides a family-centered and coordinated system of care for children with special health care needs. Dr. Stein travels to Ft. Pierce once a month to provide quality care to these children who need it most.

Palms West Hospital is lucky to have such a dedicated physician, as Dr. Stein, involved in our leadership and in our community.



For more than 20 years, Patrick M.J. Hutton, M.D., MBA, has been a member of the Florida Orthopaedic Society (FOS). Now its new president, he is looking forward to leading the organization’s educational efforts in the state and participating in legislative and lobbying efforts.

“One of the issues that is very important to the Florida Orthopaedic Society is improving access to musculoskeletal care for patients in Florida, and I have made that one of my goals,” he explained. “I also plan to be involved in the healthcare reform that is coming on a national level; helping orthopaedic surgeons in the state deal with reform changes by finding the best ways to help them with practice management issues.”

As a member of the American Academy of Orthopaedic Surgeons (AAOS), which has a very close working relationship with FOS, Dr. Hutton is also involved in a program to improve culturally competent care. “Our goal is to make physicians aware of opportunities that are introduced through residency programs in the state to improve diversity in the orthopaedic profession, which in turn, improves care to our patients,” he said. In addition to providing information in a guidebook and CD-ROM, the Academy provides training seminars to residency programs, and the course will soon be available to orthopaedic surgeons online.

“We have a diverse patient population in Florida; instead of talking about a minority population, we’re actually talking about an emerging majority population,” he continued. “The Hispanic, African-Americans and Pacific Rim populations are increasing at a faster rate than the traditional white population in the state.”

According to Dr. Hutton, a person’s cultural background may determine how they accept care. “If I say something to a person from Georgia, it may mean something different to someone in New York state, or Puerto Rico, or Mexico or Manila,” he explained. “We need to tailor our care; even if we’re providing the same care to all of our patients, it doesn’t mean that we’re giving equally good care to everyone.”

Dr. Hutton also plans to participate in the Wounded Warriors Project, whose national headquarters is based in Jacksonville, Florida. “The Academy already has an Extremity War Injury Program, and we would like to tie that into the Wounded Warriors Project in order to help returning veterans adjust to civilian life once they are discharged from the military,” he said.

“There have been major strides made in war injuries research—injuries that soldiers would not have survived in Vietnam, they can now survive,” he added. “Because of better body armor, we are seeing more extremity injuries. There are a lot of advances in what can be done in limb salvage procedures and prosthetics.”

A former flight surgeon in the Navy, Dr. Hutton graduated from St. Joseph’s University in Philadelphia and then attended New York Medical College. He served in the Navy from 1969 to 1995. “There have been a lot of changes in the field since I was an orthopaedic resident in 1978,” he said. “In 1974, arthroscopic surgery had just been introduced in the U.S. –now it constitutes 70 percent of my operative practice. The changes in total joint procedures for hips, knees and shoulders have also advanced remarkably.”

As for the future, Dr. Hutton expects to see even major innovations in medical care, not only in orthopaedics, but across the board. “I think from a technical standpoint, we’ll see advances in antibiotic care and genetically engineered drugs,” he said. “I believe that better biological materials will extend the lifespan of replacement joints, and I also think that we’ll see a dramatic increase in the number of total joint procedures as baby boomers hit their 60s and 70s.”

One concern, however, is that there won’t be enough orthopaedic surgeons in the state to meet this growing demand. “We’re in a bad situation in Florida in that medical school graduates are leaving the state because there aren’t enough residency spots in orthopaedics to take them in,” he said. “Statistics show that 70 percent of physicians practice in the state where they did their residency. In Florida, we’re faced with an aging population and not enough residents, which will cause a real shifting of specialty care in orthopaedics.”

Dr. Hutton plans to work with future FOS presidents to create long-term plans to deal with this and many other issues. “The patient is our primary focus,” he said. “We will work together to provide better, more accessible care for our patients now and in the future.”



Leaders in today’s health care environment must focus on rendering services along the continuum of care for the customers we serve. Simultaneously, leaders must include a strong focus on integrating and arranging an organization that fosters point-of-service accountability and decision-making. It is at point-of-service that most all of the decisions are made and this decision-making is what makes any organization successful. A strong customer focus is the foundation for all activities and job descriptions in the organization. Therefore in order to be successful, we must examine our workforce, structures and model of care delivery systems to enhance that foundation and build upon it. Leaders must focus on resources available to staff while supporting them in their efforts to get the work done.

Accountability is a core standard for leadership and it is imperative that leaders invoke that standard into the standards and expectations of their staff. There must be a shift from the locus of control to accountability and that shift should be directed towards those providing the care. Leaders must take a hard look at the partnership they share with their employees in terms of accountability and be flexible to change in order to partner and support. Staff cannot establish accountability for work that they do not share without direction, control and approval. If accountability and equity are not shared, the system will not support the efforts of the caregivers and staff will never experience ownership to their work. When staff is dependent on their managers to make decisions for them, creativity is stifled. This results in staff lacking motivation and ultimately lacking the most precious buy-in to the processes. It is a leader’s responsibility to ensure that accountability is defined, refined and clear as this is critical for building accountability in any organization at each and every level. Accountability is not given or assigned but rather assumed. Performance expectations must be clear and understood as well as embedded in the job of the employee at the bedside. It is imperative for those delivering the services at the bedside to be aware of both rewards and consequences that are associated with accountability.

Service is so very important to the business of health care which makes it imperative that decision-making and accountability for those decisions is kept at the level they belong. It must not only be clearly understood but clearly owned by the staff or the service delivered will be lacking the substance it deserves. Staff needs empowerment and freedom to serve their customers while the organization should be right there to support their moves. The structures in place for care delivery must reflect the foundation of service as service delivery is built around the customer and not around departments and processes.

Leaders need to take the lead in acquiring new rules for their behaviors to ensure that staff is accountable. There should be no “mom and dad” type relationships, no codependency behaviors, no parental checking and no more taking on other people’s problems. Managers must be much more serving to their staff and less directing. Managers are challenged to become more relationship-oriented with their staff and less distant. And, in the end all of us are challenged to be accountable for what we say and do. Authors B.J. Gallagher and Steve Ventura (2004) wrote about success through personal accountability titled: Who Are “They” Anyway? Here are their ten most important words of personal responsibility that managers should take hold and be sure to share with their staff:

The 10 most important words:
I won’t wait for others to take the first step.

The 9 most important words:
If it is to be, it’s up to me.

The 8 most important words:
If not me, who? If not now, when?

The 7 most important words:
Let me take a shot at it.

The 6 most important words:
I will not pass the buck.

The 5 most important words:
You can count on me.

The 4 most important words:
It IS my job!

The 3 most important words:
Just do it!

The 2 most important words:
I will.

The most important word:
Me

I agree.



What a great way to describe the night staff of Hospice of Palm Beach County (HPBC). When the world is asleep, they are there to be a friend to their patients. “With less hustle and bustle than the daytime, the night shift staff really has the opportunity to connect with our patients,” said Bill Rascoe, HPBC Regional Manager – WPB Central Area. “They listen to them, as a friend, sometimes sharing their own stories or feelings, even a laugh. Most importantly though, they create a bond with a patient or family member that many are thankful for at such a difficult time in their lives.”

“Here at Hospice of Palm Beach County we are lucky to have some of the most incredible staff, said Jennifer Martinez, Communications Manager for HPBC. “We have the most compassionate, autonomous, empathetic nurses to care for our patients and families at the time of their greatest need. Whether it is just a small gesture like stopping by to say hello, or being somebody to talk to, every thing our staff does makes a huge impact on a patient’s well being and a family’s comfort at such a challenging time.”

William Lazo, R.N., Dora Berrio, R.N., Marie Louis, C.N.A.

And, as the rest of the world sleeps, HPBC’s night shift keeps everything running smoothly. “I have worked the night shift for many years,” said Barbara Cameron, Charge Nurse at HPBC’s Gerstenberg Inpatient Unit. “I feel it gives me a better opportunity to connect with my patients. Though we still have a lot of work to do, we don’t have to worry about meals or visitors. We really have the opportunity to have a conversation with our patients.”

Being a part of the night shift also gives staff the opportunity to serve as the eyes and ears for the rest of the care team. They can monitor the patients while making them feel safe, feel cared for and feel like they truly have friends here. And, though everyone has a different perspective on how they can help, everyone makes a difference.

So, the next time you lie awake at night, unable to sleep, think of the impact the night staff of Hospice of Palm Beach County is having on someone at that very moment. They truly are an invaluable part of the Hospice of Palm Beach County team.



Healthcare is in the midst of tremendous change. 2010 promises to be a year filled with changes that will impact all of us and the patients we treat. One of biggest challenges facing all of us is that we do not know what healthcare reform will look like. It is hard to plan and anticipate for a change that we cannot fully predict. Significant change is clearly coming. How that change will manifest is not nearly so clear. Actions are taking place right now in Washington that will have a huge impact on healthcare for decades to come. These changes are being hammered out in the committees and subcommittees in congress. The conclusions they reach and decisions they ultimately make will affect us, our children and our children’s children.

It has often been said that the best defense is a good offense. Now is exactly the time when we All need to be very pro-active. We all need to be aware of what changes are going to be proposed at a minimum. Ideally, we all need to become more politically active. Reach out to your elected officials. Let them know what is important to you. If you have ideas of how things could be better, share those. There is no question that change is coming. The only question is how much of a say we all will have in how that change will manifest.

There is strength in numbers. All of us who work in healthcare need to be united in our efforts to be active participants in this change. Regardless of our political backgrounds, we all share a single overriding goal: to provide the best care possible to whose who entrust their healthcare to us. We need to put aside our personal differences and stand together bonded as we are by this common goal.

The challenges facing all of us are tremendous. Living with uncertainty can be very stressful. I urge all of you to channel this uncertainty into something positive. If you do not know what healthcare changes are being proposed, find out. If you do not have a good understanding of how the process of healthcare reform is being percolated through congress, get informed. If you have an interest in getting involved in the political process, do it now. There may never be a more crucial time for all of us who care for patients to stand up and be heard than right now. Find out what the issues are, let your opinions be known, and get involved in helping put those opinions into action.

Times of great challenge are invariably times of great opportunity. Let all of rise to this occasion. Our patients deserve nothing less. If we do not speak up for those who rely on us, who will? Let 2010 be remembered as the year that we all stood up, all spoke out, and all did all we could to help our nation emerge from this time of tremendous change with the best possible healthcare system.