Great Expectations

Hope Ricciotti, M.D.

Hope Ricciotti, M.D.Hope Ricciotti, M.D., has a rule. “Every time I am working on labor and delivery or seeing patients in the office, I always have to learn one new thing,” says the chair of the Department of Obstetrics and Gynecology. “And whenever I am working with residents and medical students, we have to learn one new thing. The sum total of those new things is a mountain of knowledge by the end of the year.” Over her 20-year career at Beth Israel Deaconess Medical Center, Ricciotti has amassed a wide range of expertise. Her quest for knowledge is aided by her vast breadth of work extending from helping women establish best practices for health during pregnancy, to educating future generations of ob/gyn clinicians, to improving clinical and administrative workflow for her colleagues. “Patients have come to our institution in droves because of the quality of the care, patient satisfaction, and physician satisfaction,” Ricciotti says. “This department was founded with a real theme of commitment to patient safety, teamwork, and team training. It is not that we just say we are high-quality, we can really prove it — and yet we never rest on our laurels.”

Choosing obstetrics and gynecology as a specialty was an easy decision for Ricciotti, partly because of the clinical aspects of the field, but also as a personal mission to dispel health care disparities for women and provide comprehensive women’s health and reproductive care. “When women control their reproductive health, it allows them to be equal partners in society and contributing members of society,” she says. “In the U.S., we are very lucky because women have better access to care and therefore can better control their reproductive health, but worldwide that is not the case. It may come as a surprise, but we still have work to do.” For seven years prior to being named chief last March, Ricciotti split her clinical practice time between the medical center and the BIDMC–affiliated Dimock Center in Roxbury where she aimed to improve access to superior care for an urban population. “I was attracted to that work because of the challenges of disparities we see in our own backyard — much higher preterm labor rates, higher cervical cancer rates—all the things that happen when women don’t have good access to care,” she says. Among many responsibilities, she focused her clinical and research efforts on improving family planning, reducing teen pregnancy, and reducing preterm delivery among women in the community.

Hope Ricciotti, M.D.Now as chief of the department at BIDMC, Ricciotti spends more of her time taking care of patients at the medical center. However, she still brings the same mentality of helping women achieve a healthy baby and healthy body. “We look at pregnancy as a great teaching time,” Ricciotti says. “It is a time when women will quit smoking, start exercising, and start taking better care of themselves because they are doing it for two.” In the process of educating women about what they can do to eat healthy and be healthy, Ricciotti and her colleagues discuss a new category of research known as epigenetics, or fetal origins of adult disease. “The diet that a baby is exposed to while in utero can have enormous effects on its health later in life,” she says, noting research has shown the potential for reducing cardiovascular disease, obesity, and even cancer. She helps her patients understand that prevention starts early—even in the womb—and foods such as fruits, vegetables, and whole grains can improve well-being later in life.

Ricciotti’s interest in prenatal nutrition stems from her personal life and her husband, Vincent Connelly, who works as a chef. “When I was pregnant with my first son, I knew what I was supposed to eat, but nothing tasted good because I was pregnant,” she recalls. “My husband started tailoring foods for me, and we thought it was a great idea for a book.” Ricciotti and Connelly released The Pregnancy Cookbook in 1996 and followed up with I’m Pregnant! Now What Do I Eat? “Women used to think about ‘eating for two,’” she says, “that they could eat anything and everything they wanted, and it turns out not to be the case. With a higher percentage of the population being either overweight or obese, we spend a lot of time helping women target a healthy gain as opposed to anything and everything.”

Educating patients and future clinicians is the foundation of Ricciotti’s somewhat non-traditional ascent to chair of the department. The former BIDMC vice chair for education and current residency program director is actively involved in the creation and reform of the curriculum at Harvard Medical School and is one of two clinicians from Boston-area teaching hospitals to represent clinical programs as part of the curriculum committee. “I love the creativity that goes with that process and working with some of the most gifted and brilliant students,” Ricciotti says. “They keep me inspired and always thinking.” She describes BIDMC’s Department of Obstetrics and Gynecology as the small-college experience of the Harvard teaching programs. “People who come here have unique ideas and perhaps want a faculty position that is not one-size-fits-all,” she says. “We see what everybody else sees, but we think what no one else thinks. We are trying to tackle the most vexing problems that affect women’s health care at the highest level.”

Not only is Ricciotti motivated to innovate in the classroom, she also wants to be creative in redesigning academic space to promote a better work environment for physicians and scientists. In 2011, she analyzed the use of space in the ob/gyn academic offices and worked with facilities management and architects to develop a new floor plan. In a major renovation, they eliminated private offices for open workspace and built team rooms and common areas to improve collaboration and communication. “The institution gave me a chance to innovate in our academic space,” she says. “I would like to do the same thing for the ambulatory setting. We are hoping to take this urban real estate and get more out of what we have by making it a better place to see patients, a better place for staff to work, and more efficient per square foot. With philanthropic help, we could become a national model for how to deliver better care.”

Hope Ricciotti, M.D.That desire for innovation is essential as the department is faced with one of its biggest challenges in Ricciotti’s tenure. Since BIDMC finalized an affiliation with Atrius Health to be its provider of choice for tertiary care, ob/gyn has been operating at full capacity. Since March, Atrius has been sending all obstetrics patients to deliver their babies at Beth Israel Deaconess and its affiliated community hospitals. While most low-risk births take place in the community, if the baby or the mother requires a higher level of obstetric care—which accounts for approximately 10—15 percent of all births—they are transported to BIDMC. As a result, the medical center will exceed its capacity of 5,000 births per year by approximately 50 to 100 births, according to Ricciotti. To meet the demand, the unit is also at maximum staffing capacity with 90 practicing physicians. “Facilities and staffing are an enormous constraint for the perinatal service right now,” Ricciotti says. “We have a renovation planned which will not even touch the need to expand capacity. It will allow us to improve collaboration, but it doesn’t add one single labor room.” Meeting this challenge is critical because Ricciotti recognizes that obstetrics is often the first entry point in terms of cementing a family’s loyalty to a hospital. “It is very important for us that you are getting the highest level of care, but with a personal touch,” she says. “I want patients to feel like they are an equal partner in their care.”

As a leader at BIDMC and in the ob/gyn field, Ricciotti strives to be a role model and a mentor. “I didn’t give up my entire life to be in this role,” says the mother of three boys. “I have a life as well as a professional life, and I believe those things are very much intertwined.” She is a self-confessed “high-tech gadget girl” who never carries a pen or paper and is rarely far from a laptop or iPhone. Her desire to constantly improve herself, her staff, and her facility while providing compassionate, patient-centered care is unyielding. “I always try to ask the questions that have been vexing for us, knowing that students will hear those questions and think differently than perhaps I would when I am asked the same question,” she says. This way, she is guaranteed to learn a new thing every day.


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