Biographies. *Sheila Agyeman, MHA Project Manager Delmarva Foundation for Medical Care

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1 *Sheila Agyeman, MHA Project Manager Delmarva Foundation for Medical Care Ms. Agyeman joined Delmarva in June 2005 as a Project Manager for the hospital team and worked with the Maryland Patient Safety Center (MPSC) on the Emergency Department Collaborative project. She is currently the project manager for MPSC s Perinatal Collaborative. She earned her Master s degree in Health Systems Administration (MHA) from Georgetown University s School of Nursing and Health Studies and her Bachelor of Arts degree in Biology from St. Mary s College of Maryland. Her previous work experience includes various positions as a clinical administrative associate with Georgetown University Hospital and Boston s Children s Hospital. Ms. Agyeman has also held positions as an intern at Mercer Human Resource Consulting in their Health & Group Practice and at Sibley Memorial Hospital s Human Resource Department. She is a member of the Project Management Institute and the American College of Health Care Executives. Alan David Bedrick, M.D. Chief, Section of Neonatology Department of Pediatrics Franklin Square Hospital Center Dr. Bedrick received his B.S. in Biology from The Pennsylvania State University and went on to earn his medical degree from the College of Medicine, The Milton S. Hershey Medical Center. He served as a resident in the Department of Pediatrics at The University of Arizona College of Medicine prior to receiving his fellowship in Neonatology from State University of New York Upstate Medical Center. He is currently an assistant professor of pediatrics at the University of Maryland School of Medicine. Dr. Bedrick presently serves as chief of the section of neonatology as well as medical director of the neonatal intensive unit. He is a member and chair of the Baltimore Regional Advisory Group and the Maryland Institute for Emergency Medical Services System Perinatal Advisory Committee. Raymond L. Cox, M.D., MBA, OB/GYN Chair, Department of Obstetrics and Gynecology St. Agnes Hospital Dr. Raymond Cox earned his bachelor s degree from Howard University and his medical degree from the University of Pennsylvania Medical School. He completed his internship and residency in Obstetrics and Gynecology at Grady Memorial Hospital-Emory University in Atlanta. Dr. Cox earned his Master s in Business Administration from Johns Hopkins University. He most recently served as Director of OB/GYN Services at Prince George s Hospital Center. Dr. Cox has long focused on delivering high-quality health care to underserved women. In addition to serving in the Maryland Section of the American College of Obstetricians and Gynecologists, he chairs the organization s Committee on the Health of Underserved Women.

2 Joseph Derrough, MD Obstetrician/Gynecologist, Medical Co-Director, Patient and Safety Physician Chair, Perinatal Patient Safety Project Kaiser-Permanente, San Jose Dr. Derrough resides as the Medical Co-Director of Patient Safety for Kaiser-Permanente San Jose where he also serves as the Physician Chair of the Perinatal Patient Safety Project. The perinatal team that Dr. Derrough chairs is one of the four original Kaiser-Permanente perinatal pilot sites. In 2004 the four pilot sites were presented with the David Lawrence National Patient Safety Award for their ground-breaking work in reducing medical errors. Dr. Derrough is a native of San Francisco; he attended medical school at the University of California, San Francisco and is a graduate of the Ob/Gyn Residency Program at Kaiser Foundation Hospital San Francisco. He is an active patient safety and human factors presenter and consultant and is currently a guest faculty member with the Institute for Healthcare Improvement's Perinatal Impact Teams. Dr. Derrough's principle interests in patient safety (beyond the perinatal arena) include: human factors, communication between and among physicians and nurses, critical events team training, safe systems design, and cross-cultural barriers to patient safety. When not involved in patient safety activities, Dr. Derrough delivers babies and performs gyn care in San Jose. Jenifer Osorno Fahey, CNM, MSN, MPH Nurse Midwife, Perinatal Outreach Coordinator Instructor, Department of Obstetrics Gynecology and Reproductive Sciences University of Maryland School of Medicine Ms. Fahey is currently an Assistant Professor at the University of Maryland School of Medicine in Baltimore, Maryland. In addition to her clinical duties (full scope midwifery) and her faculty duties (clinical and classroom instruction of medical students and Ob/Gyn Residents) she is also the Perinatal Outreach Coordinator and has, in conjunction with the Chair of the department, set up and operates an obstetric simulation program. She serves on multiple task forces and work groups aimed at improving the health of mothers and infants in the state including the Editorial Board of the Maryland Perinatal Network newsletter, the Maryland Patient Safety Task Force, and the Baltimore Babies Born Healthy Leadership in Action Program. Ms. Fahey obtained her B.A. from the University of Texas in Austin in 1994 and then went to Harvard University s School of Public Health where she obtained a Masters of Science in Public Health in Upon completion of her public health masters, Ms. Fahey went to New Haven where in 2000 she completed her Masters of Science Nursing in the Midwifery division of the Yale School of Nursing.

3 *Bonnie J. Horvath, MHSA, CHE Project Manager Delmarva Foundation for Medical Care Ms. Horvath joined Delmarva in 2006 as Project Manager responsible for the Academic Chronic Care Collaborative Knowledge Transfer Project funded by the Agency for Healthcare Research & Quality, and an active part of the project team for the MPSC Perinatal Collaborative. Prior to Delmarva, Ms. Horvath served as Director, Network Integration for the Northeast Cluster of the National Health Disparities Diabetes Collaborative initiative of the Bureau of Primary Health Care, Health Resources and Services Administration. Ms Horvath has over fifteen years experience teaching quality improvement principles and methods and leading/facilitating improvement initiatives. She has held Performance Improvement/Quality Improvement Director positions with Community Health Integrated Partnership, Baltimore Medical System, Bon Secours Baltimore Health Corporation, and the Children s National Medical Center. She received her Masters Degree in Health Service Administration from the George Washington University, a B.A. from University of Baltimore and an A.A. in Nuclear Medicine from Essex Community College. Ms. Horvath is a Certified Healthcare Executive in the American College of Healthcare Executives. Brigid Maguire Krizek, RN, BSN, MGA, CPHQ, CPHRM American College of Obstetricians and Gynecologists, Washington, DC Director, Quality and Patient Safety Ms. Krizek is a master s prepared healthcare administrator with experience in acute and managed care. She is currently responsible for the development of the patient safety and growth of quality activities of the non-profit organization of women s healthcare physicians. Her leadership skills include developing an integrated approach to patient safety, quality, risk and medical management; strong data mining, analysis and presentation skills. Ms. Krisek has experience with JCAHO, CMS and NCQA accreditation: standards, compliance, and corrective action planning. *Sandra Ellen Lesikar, PhD, Senior Scientist Delmarva Foundation for Medical Care Dr. Lesikar joined Delmarva Foundation in 2003 as Senior Scientist. Currently she is responsible for developing and implementing strategies for priority setting in terms of targeted areas for improvement or focused investigation. She is also responsible for trending administrative data to understand opportunities for improvement or focused investigation, developing and testing hypotheses on causation of variances and outliers, and designing statistical and methodological strategies. Dr. Lesikar creates statistical and develops interventions, preferably system changes, for improvement. She has recently completed a nine-month Improvement Advisor Fellowship with the Institute for Healthcare Improvement (IHI); earned her Ph.D. in Psychiatric Epidemiology from the Johns Hopkins University, School of Hygiene and Public Health, Department of Mental Hygiene; and her Bachelors degree in Psychology from Washington University in St. Louis.

4 *William F. Minogue, M.D., FACP Director Maryland Patient Safety Center Dr. Minogue did his undergraduate work at Seton Hall University and received his B.S. in Chemistry. In 1952 he entered the US Navy and achieved the rank of Lieutenant, serving on the Heavy Cruiser Helena (CA-75) as Deck Watch Officer and Main Battery-Gunnery Officer. He returned to New York City to attend the New York Medical College with his post graduate training (internship and residency) at St. Vincent's Hospital, New York, NY. As Director of the Maryland Patient Safety Center (MPSC), Dr. Minogue works closely with and shares responsibility with a Leadership Council consisting of representatives from the Delmarva Foundation and the Maryland Hospital Association. He acts as a primary liaison between the MPSC and Maryland hospitals in their efforts to apply better models towards safer practices and serve as the liaison between the MPSC and health care organizations (e.g., LifeSpan, HFAM, MedChi) in addition to hospitals. Dr. Minogue represents the MPSC to the media and other relevant parties, including legislators and regulators and shares the activities of the MPSC with providers and provider organizations through visits and presentations to groups such as hospital medical staffs; hospital and nursing home ownership, management and governance; and provider professional associations. He also attends state, regional, and national meetings as the primary MPSC representative. Russell W. Moy, M.D., M.P.H. Director Family Health Administration, Department of Health and Mental Hygiene Dr. Moy is the Director of the Family Health Administration, Maryland Department of Health and Mental Hygiene (DHMH). The Family Health Administration oversees a broad array of public health programs in Maryland, including maternal-child health, children with special health care needs, genetics, WIC, primary care, chronic disease prevention, injury prevention, tobacco use prevention, oral health, and health promotion. He has served in a number of roles at DHMH since 1989, including Director of the Office of Maternal Health and Family Planning and Director of the Community and Public Health Administration. Dr. Moy received his M.P.H. (Master of Public Health) from George Washington University in 1991, M.D. from the University of Maryland in 1979, and B.S. from the University of Maryland in Dr. Moy completed his residency training in obstetrics and gynecology at the University of Maryland Hospital in 1983 and is a Fellow of the American College of Obstetricians and Gynecologists.

5 Janet H. Muri, MBA Vice President National Perinatal Information Center/Quality Analytic Services Ms. Muri has served as Vice President of the National Perinatal Information Center/Quality Analytic Services (NPIC/QAS) since She joined NPIC/QAS in 1988 serving initially as a consultant, then Data Coordinator, Director of Information Services, and Associate Director prior to her present position. Ms. Muri oversees all collection, processing and analysis of clinical and financial data submitted by NPIC/QAS member hospitals and other state, federal and private data sources related to contract work conducted by NPIC/QAS. She is the principal on many of the NPIC/QAS contracts including the Georgia Regional Intensive Care Network project, the JCAHO Core Measure Services activities, the Department of Defense Perinatal Performance Activity and the Harvard Risk Management Strategies Foundation Team Performance Plus contracts. Ms. Muri is also a lead consultant on all the Perinatal Consulting Group engagements. Ms. Muri has a Master s in Business Administration (cum laude) with a concentration in Health Care Management from Boston University. Benjamin Paul Sachs, MB. BS, DPH, FACOG Chief Obstetrics and Gynecology Harold H. Rosenfield Professor Obstetrics, Gynecology and Reproductive Biology Professor, Harvard School of Public Health Beth Israel Deaconess Medical Center Benjamin P. Sachs, MB. BS, DPH, FACOG, Obstetrician and Gynecologist-in-Chief at Beth Israel Deaconess Medical Center, Harold H. Rosenfield Professor of Obstetrics and Gynecology at Harvard Medical School, Professor Obstetrics and Gynecology Harvard School of Public Health, President of the Beth Israel Deaconess Physician Organization. Dr. Sachs has been a member of the faculty of BIDMC since 1982 and was appointed chief in He also serves as President of the Beth Israel Deaconess Physician Organization and Chair of the Executive Committee of the Department of Obstetrics and Gynecology at Harvard Medical. A graduate of St. Mary s Hospital and Medical School (Imperial College, London England) and received a degree in public health from the University of Toronto and completed a residency in obstetrics and gynecology at the Boston Hospital for Women and a fellowship in maternal-fetal medicine at Brigham & Women s Hospital. Dr. Sachs has placed a special emphasis on public/preventative health care and patient safety. He has been involved in international initiatives including a women s healthcare program in Yerevan, Armenia, Dniepropetrovsk in the Ukraine and Manila, Philippines.

6 Larry L. Smith, JD Vice President, Risk Management MedStar Health Mr. Smith is Vice President and Director of Risk Management services for MedStar Health, the largest community-based not-for-profit healthcare provider in the Baltimore-Washington, D.C. area. Serving also as president of MedStar s captive insurance company, Greenspring Financial Insurance Limited, Inc. of Cayman, he is responsible for the design, implementation and administration of MedStar s broad and comprehensive risk management, self-insurance and commercial insurance program. Prior to joining MedStar in 2001, Smith was the chief risk officer for UCSF-Stanford Health Care in San Francisco, California. There he developed and implemented a program of insurance and self-insurance programs to address the needs of a large integrated healthcare delivery system that combined the academic and community healthcare programs of both Stanford University and the University of California Medical Center at San Francisco. Mr. Smith served for a number of years as executive vice president and general counsel of New England Medical Center (NEMC) in Boston, Massachusetts. As NEMC s general counsel, he served as chief legal advisor to the Center s CEO, board of directors, administrators and medical staff. *Margaret Toth, MD Chief Quality Officer Delmarva Foundation & Maryland Patient Safety Center Dr. Toth graduated with honors from the Yale University School of Medicine in 1991 and completed her post-doctoral training in Internal Medicine at the University of California at San Francisco (UCSF). Her undergraduate degree from Case Western Reserve University is in Medical Anthropology. Dr. Toth draws on her extensive background in patient safety and quality improvement to oversee Delmarva s safety, culture and innovation contracts. She has been instrumental in the design and execution of the Maryland Patient Safety Center ICU Safety Culture Collaborative Series, the Agency for Healthcare Research and Quality (AHRQ) High Reliability Organization Learning Network, and the Maryland and District of Columbia Medicare Quality Improvement Organization (QIO) Core and Special Study Contracts. Prior to joining the Delmarva Foundation, Dr. Toth was the Medical Director for Ohio KePRO, the Medicare Quality Improvement Organization for the state of Ohio. As the Senior Provider Interventionist for the Medicare Quality Improvement Community (MedQIC), Dr. Toth authored the Transform! MedQIC Approach to Change, the guiding force behind the informational structure for the MedQIC 2.0 website. Dr. Toth is Board Certified in Internal Medicine and her healthcare experience includes roles as an Attending Physician and Clinical Instructor in General Internal Medicine at The Cleveland Clinic Foundation and the MetroHealth Medical Center

7 Jennifer Ustianov, BSN, RN Project Director National Initiative for Children s Healthcare Quality and The Vermont Child Health Improvement Program Ms. Ustianov is Project Director with the National Initiative for Children s Healthcare Quality and the Vermont Child Health Improvement Program. Ms Ustianov has extensive knowledge in QI and is currently the Director and Consulting Director of several projects focused on improving outcomes for pregnant women and their families. HRSA S Perinatal and Patient Safety Pilot Collaborative, part of the Bureau of Primary Health Care s Health Disparities Collaborative Initiative, is a national improvement pilot project, working to improve the disparities in the rate of infant mortality with a focus on the African American population through ground breaking health system changes; LA Best Babies Network Healthy Births Care Quality Collaborative and Improving Prenatal Care in Vermont (IPCV), are statewide initiatives aimed at improving the quality, delivery and coordination of prenatal care in Obstetrical, Family Practice and Certified Nurse Midwives office settings; Crew Resource Management: Communicating for Patient Safety, an initiative in a regional perinatal unit that focuses on improving outcomes, team process and communication which lead to reductions in preventable harm; Improving Care for the Opioid-exposed Infant (ICON), an innovative project focused on improving the coordination of care and health outcomes for opioiddependant pregnant women and opioid-exposed infants. *Carmen Tyler Winston, MHSA, BSN, BA Vice President, Quality Improvement Programs Delmarva Foundation for Medical Care Ms. Winston has more than 25 years of healthcare experience in ambulatory health care, physician group-practice management, home health care and long-term care. She joined Delmarva Foundation in January 2004 as Director, Quality Improvement Programs. At Delmarva, Ms Winston works with both the Hospital and Physician Office Teams. Her Delmarva responsibilities include contract work with the Centers for Medicare and Medicaid, CareFirst BlueCross BlueShield, the Maryland Patient Safety Center and others. In addition, Ms Winston is a Certified Professional in Health Information Technology and a Certified Professional in Electronic Health Records. Previous to joining Delmarva, Ms. Winston served as the Director, Survey Management, at the National Committee for Quality Assurance (NCQA) in Washington, DC. As Director, she was instrumental in transitioning NCQA s paperbased assessment tools into web-based tools. In addition, she successfully led the implementation of several new product lines. Ms. Winston holds a Masters in Health Services Administration from The George Washington University, Washington, DC; a Bachelors of Science in Nursing from Cornell University-New York Hospital School of Nursing, New York, New York; and a Bachelors of Arts from Clarion State University, Clarion, Pennsylvania. She is currently enrolled in the Graduate Certificate Program in Biomedical Informatics at Oregon Health and Science University, School of Medicine, Portland, Oregon.

8 *Maryland Patient Safety Center Staff Member Planning Committee Member Support for the Perinatal Collaborative was provided by a grant from the Maryland Department of Health and Mental Hygiene Center for Maternal and Child Health.