Charles F. Mullen

Thank you, Barry, for the warm welcome and your kind remarks. It is a pleasure to be back in Boston to celebrate a commitment to excellence in community collaboration and the creation of the New England Eye Institute.

Honored guests.

This morning, I would like to share with you the beginnings of optometry’s first program to collaborate with community health centers to improve access to eye and vision care services and enrich optometric clinical training.

I will attempt in my brief remarks to relate the common elements of the initial program to the new corporate structure and community governance model of the New England Eye Institute. I plan to outline the challenges which, I believe, still lie ahead for the new organization and finally, with your permission, offer a few observations or suggestions from my years of experience in interprofessional cooperation.

In the late 60’s and the early 70’s, the New England College of Optometry decided to expand and enrich the clinical training environments to which its students had access.

We knew that optometry students would benefit from health care environments in which the optometrist was one of many health care professionals contributing to the care of the patient.

Inner-city demographic data suggested that students would have the opportunity to participate in the care of patients with serious eye and vision problems unlike the university students they typically examined at the College’s Kenmore Square Clinic.

We wanted students to learn in a quality health care environment and not a teaching clinic as was customary at that time. Quality clinical training could only be achieved in a quality health care setting.

Coincident with our educational mission and not at all incompatible with it was a commitment to providing eye and vision care services to inner-city residents who were unable to meet this health care need in their own communities.

We concluded that the most promising scheme for fulfilling both our educational and community service objectives was to form an innovative network of affiliations with existing health care centers. Innovation was an important element in the development of the clinical network as it is today for the New England Eye Institute.

As we began to develop the program, any illusions we may have had about the ease of executing our new strategy were quickly dispelled. We learned a lot about skills we thought had nothing to do with eye care or optometric education: about convincing skeptics, compromising, introducing safeguards, planning, and negotiating.

In the first place, there was a reluctance on the part of health center administrators to permit students to participate in their programs.

Historically, the health center community was disenchanted with receiving its health care in the emergency rooms of large teaching hospitals and our proposed program, they thought, was precisely what they were seeking to escape.

Our second problem revolved around the reluctance of medical staffs at some health centers to work directly with optometrists, since the physicians had little experience working with us.

It was necessary to convince the medical staff at a very fundamental level of the ability of optometrists to function in and contribute to an interdisciplinary environment.

We also encountered considerable political pressure from the ophthalmological society which opposed cooperation between optometry and ophthalmology in the new eye and vision care model to be developed in the community health centers.

I am always reluctant to single out individuals for fear of omissions, but I would be remiss without citing the bold leadership of a few who were responsible for the success of the 70’s community eye care initiatives: Health Center administrators, Jim Hooley, Dorchester House, Mel Scovell and Tris Blake of the South End Community Health Center and Bob Morgan of the Dimock Community Health Center in Roxbury. Bill Baldwin, President of the New England College of Optometry for granting me the opportunity to participate in the development of the clinical network.

The optometrists who were willing to pioneer a new approach to interprofessional collaboration: faculty from the New England College of Optometry–Ralph Levoy, Jerry Selvin, Matt Garston, Jeff and Neal Nyman and the young Barry Barresi.

And, three courageous ophthalmologists, David Miller from Beth Israel Hospital and Harvard and Marc Richman and Andre Quamina from Boston University, who believed in the new model and were committed to providing comprehensive eye and vision care to the community health center clients. They withstood the persistent political pressure and the new optometric-ophthalmological interactional model was implemented at the South End and Dimock Community Health Centers and the Dorchester House for the first time in the United States. Bold leadership was as important then as it is now.

This eye care protocol has now evolved throughout the country, more recently into a comprehensive affiliation among the Illinois College of Optometry, the University of Chicago Medical School and its University Hospital System for the provision of ophthalmic care, medical and optometric education and research.

And, the fourth problem had to do with the antagonism our new eye care model aroused among private optometric practitioners, many of whom were our own alumni and friends. They felt that we were intruding into an area that is rightfully theirs.

I was pleased to learn that this issue has been largely resolved through the leadership of the Massachusetts Society of Optometrists.

The common element that emerged throughout the development process was the importance of effective collaboration among all of the constituencies. Community health center boards and community advocacy groups at first were skeptical, then later became strong supporters of the effort. Their support was critical to the success of the program.

The College and health center collaboration soon began to develop into a successful story of mutual respect and aligned missions. These were the key ingredients in improving community access to eye and vision care services in the 70’s, as they are today.

After successfully negotiating a mutually acceptable agreement with the Dorchester House Multi-Service Center and after strengthening our affiliation with the U.S. Public Health Services Hospital in Brighton, we went on to develop additional relationships in Boston. The South End Community Health Center, Dimock Community Health Center, Eye Research Unit of the Joslin Diabetic Foundation, the Kennedy Hospital in Brighton, Cotting School for Handicapped Children, Department of Veterans Affairs Outpatient Clinic, and the Gundersen Eye Clinic at Boston University.

Other institutions, upon hearing of the success of our collaboration and new eye care model, asked for assistance in establishing eye and vision services. These included: the Massachusetts Institute of Technology, Harvard Community Health Plan and the University of Massachusetts at Amherst.

All of these organizations were willing then to take the risks of new programs and innovative approaches to community eye and vision care as the New England Eye Institute member organizations are willing to take the risks of new programs and innovative approaches in this exciting new venture.

In 1976, upon leaving for Philadelphia, I wrote in an article later published in the Journal of the American Optometric Association on my assessment of the initial phase of the program.

We have reason to believe that we have achieved most of our clinical development goals to a greater degree than we ever could have anticipated.

Over 45,000 eye visits were provided to community residents in 1976. Many community residents had never before received eye or vision care.

Our students are seeing more challenging patients than their predecessors saw.

They have learned from and worked effectively with ophthalmologists and with professionals in pediatrics, internal medicine, nursing, psychology, and low vision.

Faculty and students were successful in convincing many that optometrists can make an important contribution in an interdisciplinary health care setting.

A very workable eye care protocol involving technicians, optometrists and ophthalmologists was developed and implemented.

Our graduates have very different professional aspirations as a result of their community health center experience. Some went on to work in community health centers and some have become deeply involved with the whole issue of public health and some are seeking to broaden their education and assume roles in health care policy. We have a living example here today in Barry Barresi.

A new level of innovation and collaboration has been introduced in the 21st century to build on a program created in the 70’s.

A major step was taken by the New England College of Optometry by reallocating its clinical assets into a community governed organization. Even with a history of over 30 years of collaboration, much work is still needed to be done to truly transform the New England Eye Institute into a leading community services organization for Greater Boston and a model for other cities around the country. Several challenges can be identified.

Educational programs need to be expanded to include trainees not only in optometry, but also ophthalmology, medicine, nursing, and other health care professionals, such as occupational therapists, social workers, low vision and blind rehabilitation specialists.

It will not be sufficient to provide only eye and vision services, for the New England Eye Institute needs to embrace a community oriented approach to health promotion and prevention.

The new organization must be flexible and integrated to truly meet the public need. It must position the Institute to meet the needs of special populations – the homeless, the frail elderly, the home bound, the developmentally disabled, the severely visually impaired, and others.

The quality of care must be monitored and maintained with appropriate mechanisms and oversight.

And, development efforts need to be aggressive in seeking the necessary operating and capital funds to support the Institute.

Finally, I would like to conclude with a few observations based on my many experiences in interprofessional collaboration that could be applied to the New England Institute.

The key ingredients in any successful collaboration are mutual respect and aligned missions.

Innovation must be proceeded by careful planning and boldness tempered by fiscal reality.

There are few cities better positioned than Boston to achieve excellence in collaboration to meet the public need in eye and vision care services, in health professions education, and health promotion and prevention.

I urge the many collaborators in this new initiative to reflect on the approaches and successes of a few bold individuals who in the 70’s were willing to take risks of new programs and innovative approaches and apply the same persistence, commitment and risk taking to the New England Eye Institute.

Thank you for remembering me.

Dr. Charles F. Mullen
Kennedy Library, Boston, MA
May 14, 2003