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WHAT WE -- SERVICES WHAT WE --DO WHAT WHAT WE WEDO DO DO -SERVICES SERVICES SERVICES WHAT WE DO - SERVICES WHAT WE DO SERVICES Preventive, predictive && corrective maintenance Preventive, predictive &&corrective corrective maintenance Preventive, Preventive, predictive predictive & corrective maintenance maintenance Preventive, predictive corrective maintenance Preventive, predictive & corrective maintenance Asset management – accounting and lease administration Asset management – accounting and lease administration Asset Asset management management – – accounting accounting and and lease lease administration administration Asset – accounting and lease administration Assetmanagement management – accounting and lease administration

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frequency egrate high quality operations & maintenance support services through our frequency frequency frequency frequency frequency platform WHY WE DO IT -- RESULTS te-of-the-art WHY WHY WE WEDO DO DOIT IT IT- -RESULTS RESULTS WHY WE DO IT RESULTS WHY WE RESULTS WHY WE -DO IT - RESULTS Cost control Cost Cost control control Cost control Cost control Cost control Insure operation within lease guidelines Insure Insure operation operation within within lease lease guidelines guidelines Insure operation within lease guidelines HY WE DO IT - RESULTS Insure operation within lease Insure operation withinguidelines lease guidelines Maximize employee comfort & safety st control Maximize Maximize employee employee comfort comfort & & safety safety Maximize employee comfort & safety Maximize employee comfort & safety annual projected savings Maximize employee comfort & safety annual annual projected projected savings savings annual projected savings Provide a consistent, convenient, streamlined maintenance process ure operation within lease guidelines annualannual projected savings Provide Provide a aconsistent, consistent, consistent, convenient, convenient, streamlined streamlined maintenance maintenance process process Provide a consistent, convenient, streamlined maintenance process projected savings in year 2 Provide a convenient, streamlined maintenance process in in year year 2 2 Provide a consistent, convenient, streamlined maintenance process in year 2 in yearin2year Enhance value & improve patient “first impressions” ximize employee comfort & safety 2 Enhance Enhance value value &&improve improve patient patient “first “first impressions” impressions” Enhance value & improve patient “first impressions” Enhance value & improve patient “first impressions” Enhance value & risk improve patient “firstrisk impressions” Reduce regulatory as well as ovide a consistent, convenient, streamlined maintenance process Reduce Reduce regulatory regulatory risk riskas as well well asliability liability risk risk risk Reduce regulatory risk asas well as liability liability Reduce regulatory risk as well as liability risk Reduce regulatory risk as well as liability risk first class patient care Allow clients to on business; providing hance value & improve patient “first Allow Allow clients clients toimpressions” tofocus focus on ontheir their business; business; providing providing first firstclass class patient patient care carecare Allow clients to focus focus on their their business; providing first class patient Allow clients to focus theironbusiness; providing first class care care Allow clients toon focus their business; providing firstpatient class patient duce regulatory risk as well as liability risk savings on clinic savings savings on onone oneone clinic clinic

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ARKANSAS HOSPITALS | SPRING 2021 1 Independently Owned and Operated/Member of the Cushman & Wakefield Alliance

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W W W. P O W E R S - H VA C . C O M

Pulling

TOGETHER WORKING TOGETHER

10 COVID-19 Communications: Special Tools Help Contain a Virus 18 Monoclonal Antibody Treatment Fights COVID-19 in South Arkansas 23 COVID-19 “Long-Hauler” Patients 40 Compassion Tech 46 Improving Health Outcomes

IN EVERY ISSUE

5 President’s Message 7 Editor’s Letter 8 Hospital Newsmakers 9 Virtual Learning Opportunities 29 Coach’s Playbook 35 Leader Profile: Vince Leist 45 AHA Services Presents 48 Where We Stand: Vaccinating Against Covid-19

ARKANSAS

HOSPITALS Arkansas Hospitals is published by The Arkansas Hospital Association

419 Natural Resources Drive | Little Rock, AR 72205 To advertise, please contact Brooke Wallace magazine@arkhospitals.org Elisa M. White, Editor in Chief Nancy Robertson, Senior Editor & Contributing Writer Ashley Warren, Associate Editor Katie Hassell, Graphic Designer Roland R. Gladden, Advertising Traffic Manager

BOARD OF DIRECTORS

Chris B. Barber, Jonesboro / Chairman Ron Peterson, Mountain Home / Chairman-Elect Peggy Abbott, Camden / Treasurer Darren Caldwell, Jonesboro / Past-Chairman Ryan Gehrig, Fort Smith / Director, At-Large Greg Crain, Little Rock Barry Davis, Paragould David Deaton, Clinton Marcy Doderer, Little Rock Kathy Gammill, Searcy Phil Gilmore, Crossett Vince Leist, Harrison James Magee, Piggott Mike McCoy, Danville Johnny McJunkins, Nashville Gary Paxson, Batesville Larry Shackelford, Fayetteville Brian Thomas, Pine Bluff Debra Wright, Nashville

EXECUTIVE TEAM

Robert “Bo” Ryall / President and CEO Jodiane Tritt / Executive Vice President Tina Creel / President of AHA Services, Inc. Elisa M. White / Vice President and General Counsel Pam Brown / Vice President of Quality and Patient Safety Lyndsey Dumas / Vice President of Education

Spring 2021

DISTRIBUTION: Arkansas Hospitals is distributed quarterly to hospital executives, managers and trustees throughout the United States; to physicians, state legislators, the congressional delegation, and other friends of the hospitals of Arkansas. Arkansas Hospitals is produced quarterly by Central Arkansas Media. Periodicals postage paid at Little Rock, AR and additional mailing offices. The contents of Arkansas Hospitals are copyrighted, and material contained herein may not be copied or reproduced in any manner without the written permission of the Arkansas Hospital Association.

Articles in Arkansas Hospitals should not be considered specific advice, as individual circumstances vary. Products and services advertised in the magazine are not necessarily endorsed by the Arkansas Hospital Association. To advertise, email magazine@arkhospitals.org.

ARKANSAS HOSPITALS | SPRING 2021 3

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Arkansas Heart Hospital Bryant, Arkansas (currently under construction)

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PRESIDENT’S MESSAGE

Helping One Another

T

here’s one thing we keep hearing, even a year into this pandemic: "We’ll get through it together."

It feels like we’re getting there, slowly but surely.

To best serve our members, the AHA strives to foster good communication and working relationships with governmental groups, including the Office of the Governor, the Arkansas Department of Health, the Arkansas Department of Human Services, and federal counterparts including those of our six congressional delegates. The COVID-19 pandemic has strengthened even these well-established working ties, and our members are the better for it.

When a hospital or its home community sends a distress call our way, it is particularly satisfying when AHA can serve as a reliable liaison for them, working with various governmental offices to resolve their challenges.

And we learn from these challenges.

We look at each lesson learned as an opportunity to share solutions with our membership. We figure that if one hospital or community is experiencing struggles or frustration with a particular issue, others in our membership might be facing similar obstacles. So, we turn solutions into learning tools and spread the lessons learned throughout our membership.

Many of you encounter these – and catch the latest COVID-19 updates – through the now year-old weekly

phone calls AHA instituted to strengthen pandemic communication. Whether it’s the Monday calls sharing new data and policy information, or Thursday’s calls with hospital CEOs, we offer the most up-to-date information possible to keep each of our member hospitals informed.

I have commented before on the growing cooperation between hospitals that COVID-19 is fostering. It continues to be a pleasure to see these ties grow. Yes, competition still exists, but it takes a back seat to working together for our fellow Arkansans during this crisis.

A recent example occurred during February’s devastating winter storm.

As that storm brought the center of the nation to a halt, it also had a profound effect on the hospitals of Arkansas.

The community of Pine Bluff suffered

damage to its water system, and water pressure was negatively affected.

Jefferson Regional had to postpone surgeries and procedures due to the citywide water problem, and it couldn’t accept new patients while the water system was compromised.

Jefferson Regional alerted nearby hospitals in Little Rock and south Arkansas, which stepped up to receive new patients from the Pine Bluff area.

And there are lots of other examples. Hospitals continue to share data, so that the COVID-19 response in each region of the state runs smoothly and is well-coordinated. Lately, when one hospital or system finds it has an excess of vaccine, it re-distributes these precious doses to help other communities vaccinate more Arkansans.

On one of our recent Thursday CEO Forum calls, a hospital administrator mentioned that his team was running short of vaccine quantities needed to complete second-dose appointments at an upcoming clinic. Several CEOs urged that he call them; they found and transferred the vaccine he needed, and the vaccination effort was shored up.

I’ve seen this over and over again throughout the pandemic: When one hospital has difficulties, others come to its aid.

Thanks to each of you for all you are doing. And I’d like to thank our AHA team for its monumental efforts over the past year. Yes, we’ll all get through this together. That’s a fact.

Bo Ryall

President and CEO Arkansas Hospital Association

ARKANSAS HOSPITALS | SPRING 2021 5

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6 SPRING 2021 | ARKANSAS HOSPITALS

EDITOR’S LETTER

Living the

Stockdale Paradox J im Collins’s book Good to Great influences my business and personal life daily. I imagine it may be the same for many of you.

In it, Collins shows us how companies can move from mediocrity to enduring greatness. He also gives us the gift of Navy Admiral James Stockdale’s perspective on overcoming crisis.

Collins dubs it the “Stockdale Paradox” – the art of simultaneously recognizing and accepting the realities at hand while maintaining the faith that we will prevail in the end.

Stockdale was the highest-ranking officer held at the “Hanoi Hilton,” as North Vietnam’s Hoa Lo Prison was known. The most infamous prison camp of the Vietnam War, it was notorious for the suffering and indignities American prisoners-of-war endured there.

As ranking naval officer, for eight years Stockdale was both leader and guide to his fellow captives, while, like them, he was tortured, beaten, held in irons, bound, and often held in solitary confinement. He found the courage to withstand his brutal captivity by accepting reality while believing he would one day go home.

Interviewing Stockdale about his experience Collins asked, “Who did not make it out?” Stockdale replied, “The optimists. They were the ones who said, ‘We are going to be out by Christmas.’ And Christmas would come and Christmas would go. Then they’d say, ‘We’re going to be out by Easter.’

And Easter would come, and Easter would go. And then Thanksgiving, and then it would be Christmas again. And they would die of a broken heart.”

This conversation led Stockdale to share his most his most important lesson: “You must never confuse faith that you will prevail in the end – which you cannot afford to lose – with the discipline to confront the most brutal facts of your current reality, whatever they might be.”

In his book, Collins and his team identify 11 companies that go through

“Retain faith that you will prevail in the end, and confront the brutal facts of your current reality.”

-Jim Collins, relating the Stockdale Paradox in his book, Good to Great

otherwise crushing crises while maintaining an unwavering faith in their organizations’ ultimate triumph.

In a recent YouTube video, Collins says that today, we find ourselves in a Stockdale Moment. The world is in a Stockdale Moment. Our hospitals are in a Stockdale Moment. We, ourselves, are in a Stockdale Moment.

He asks us how we can engage those around us to believe we will prevail in the end, and how we can each do a better job of confronting the brutal facts as they are today, whatever they might be. He calls this “embracing the Stockdale Paradox.”

The articles in this edition of Arkansas Hospitals show how our hospitals and their exceptional staffs embrace the Stockdale Paradox, coming together to identify problems and find solutions for their communities.

We are all experiencing the enormous and overwhelming challenges the pandemic brings to society as a whole and especially to hospitals and caregivers. We know that, despite increasing vaccine availability and vaccinations occurring worldwide, there are virus variants that lurk as part of today’s reality. But we also firmly believe the world, the U.S., our hospitals, our communities, are going to persevere.

Together, we will make it through to the end of this pandemic. Embrace the Stockdale Paradox, and keep the faith.

Elisa M. White Editor in Chief

ARKANSAS HOSPITALS | SPRING 2021 7

HOSPITAL NEWSMAKERS Marcy Doderer, President and CEO of Arkansas Children’s, has been named one of Modern Healthcare’s 2021 Top 25 Women Leaders in Healthcare. The publication indicates that these 25 leaders are combatting the longstanding imbalance of gender equity at the top rungs of leadership, and that they serve as mentors and create workplaces that embrace diversity and inclusion, all while guiding their organizations through a global pandemic.

In highlighting Doderer’s accomplishments, Modern Healthcare says, “Even as the pandemic was unfolding, Doderer led efforts to get a new five-year strategic plan approved that included goals to dramatically improve health care for children in a state that ranks near the bottom of most national measures. She announced plans to expand community clinics and access to primary care and led efforts to revive an air transport program. During her eight-year tenure, the hospital has seen a 60% drop in healthcare-acquired conditions and an 80% reduction in serious safety events.” Doderer is a member of the Arkansas Hospital Association board.

Chambers Memorial Hospital in Danville recently launched a $3.3 million project for expansion and enhancement of its emergency room. Chambers Memorial CEO Mike McCoy says the project received funding from the CARES Act, which was made available to assist facilities in responding to pandemics. “The project is designed to allow us to more effectively prevent, prepare for, and respond to the coronavirus and future pandemics,” he says. The new facility will expand accessibility, provide separate patient areas in the effort to reduce exposure, and offer a waiting room that allows for adequate social distancing.

Shannon Hendrix, MS, RD, LD, is the new Senior Vice President/ Chief Administrator for Arkansas Children’s Northwest. She most recently served as Vice President, Clinical/Diagnostic Services with Arkansas Children’s in Little Rock.

Baxter Regional Medical Center

The ribbon cutting for a new Outpatient Surgery Center at Baxter Regional Medical Center was held recently, and rather than use the traditional oversized pair of scissors to cut the ribbon, surgeons used scalpels! The new, 24,000-square-foot facility will allow movement of outpatient procedures from the main hospital, which will utilize the space gained for additional operating rooms.

The new facility has four operating rooms, and it was constructed to incorporate an additional two operating rooms as needed in the future.

James Cox, MBA, is the new Chief Executive Officer at Arkansas Continued Care Hospital in Jonesboro. He previously served as Program Director of Behavioral Health Services for the White River Health System.

Just announced:

Artist's Rendering: Chambers Memorial Hospital

8 SPRING 2021 | ARKANSAS HOSPITALS

AHA is partnering with 20 other hospital associations to offer valuable leadership guidance through a five-session webinar series. State associations are joining forces to bring this new series to its members at a remarkable value. This Leadership Summit begins April 29 and includes sessions through August 19; cost for the entire series is $75 per link.

Series titles include 1)Telemedicine Post COVID-19, Hospital at Home, and Expansion of Technology.

2) Diversity & Inclusion.

3) Supply Chain Excellence in the Post-Pandemic World.

4) The Emotional Impact of COVID-19: Leading your Team and Culture Past Collective COVID PTSD to an Emotionally Healthy Workforce.

5) Rural Healthcare Delivery in Recovery.

For more, go to arkhospitals.org.

SPRING EVENTS AND VIRTUAL LEARNING OPPORTUNITIES

To protect our health care teams during the pandemic, AHA offers virtual educational opportunities and affiliate meetings. Please check the “Upcoming Events” page at arkhospitals.org for more information.

Virtual Leadership Summit

APRIL

April 15 Virtual Summit Overview

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Leadership Series at an Incredible Price

ated the digitization and virtualization of healthcare from tele

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Coming to you this spring Alliance  Who Should Participate Kraft, MD, of virtually XPRIZE cine, increasingly moving from Chair the hospital to thePandemic home. In this sessio June 17 | Supply Chain Excellence i Medicine (Bio) and summer, the sessions are available as a package a implication coming next in prevention, diagnostics and therapy and June 3 | Diversity & Inclusion (Moderated Q&A) atits  Session Overviews This virtual summit is designed for C-Suite ExecuPandemic World one-time price just $75 (that’s $15 per session!).

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COVID-1 9 Communications:

Special Tools Help Contain a Virus

By Martine Pollard

T

he cliché “building the plane as we fly it” doesn’t begin to describe the intensity health care professionals, including health care communicators, faced as COVID-19 began its race across the U.S. It would be more accurate to say that we built the plane while flying upside down over mountains through high winds and storms. But we’re still flying. We know that at some point we’ll attempt to safely land the plane right-side-up on a short runway, but that landing site is still far away and its exact location unknown.

When it’s important to influence personal decision-making and encourage clear thinking, effective communication like our plane metaphor is a powerful tool. During a public emergency like the ongoing COVID-19 pandemic, clear communication that captures attention does more than influence: It’s a tool that saves lives.

MESSAGING COUNTS

Do you remember Smokey the Bear and his admonition, “Only You Can Prevent Forest Fires,” or McGruff, the Crime Dog, reminding us that we can “Take a Bite Out of Crime?” Public Service Announcements (PSAs) and PSA 10 SPRING 2021 | ARKANSAS HOSPITALS

campaigns like these are communication tools that work for the public good. They create awareness, show an issue’s importance, convey vital information, and create a forum for engagement – all with the purpose of impacting social change. They provide effective information in the public interest, and they’re distributed across a variety of media outlets without charge.

COVID-19’s appearance sparked hundreds of PSAs in the U.S. and around the world. Wear Your Mask, Keep Six Feet of Separation, Wash Your Hands … we continue to see and hear these messages no matter where our devices are tuned.

As we learn more about the virus (and the public behavior necessary to contain it), new PSAs frequently pop up.

They’re foundational tools used by today’s communicators to influence public behavior.

Hospitals and health care systems know that strategic communication planning is indispensable, especially in times of crisis. Today, the public relies on social media, TV, radio, and the internet to get health and virus containment information. Communicating clearly across these many venues is challenging. As a nation, we’re addressing COVID-19 needs on the fly, and health care messaging matters.

Cont act Martine Pollard d@mercy.net martine.pollar 501-350-8001

**** * **** ******** NT JOIN T STATEME t of the Northwes Sent on behalf care providers Arkansas health

HERE IT COMES

COVID-19’s arrival in Arkansas became very real with Governor Asa Hutchinson’s March 12, 2020 declaration of a statewide public health emergency. Immediately, the Northwest Arkansas health care community, in partnership with the Northwest Arkansas Council, went into crisis planning mode.

Business and health care leaders prepared plans for surging of patients, increasing COVID-19 testing capacity, securing needed personal protective equipment, supporting essential front-line health care workers, developing a COVID-19-specific communications plan with multiple applications, and (most recently) collaborating on COVID-19 vaccination efforts.

They laid all competition aside to focus on a regional approach to the COVID-19 crisis. Besides the Council and its Healthcare Division, participants in the collaborative include Arkansas Children’s Northwest, Community Clinic, Mercy Northwest Arkansas, Northwest Health, University of Arkansas Medical School Northwest (UAMS-NW), Veterans Health Care System of the Ozarks, Washington Regional Medical Center, and the Whole Health Institute.

MANY CULTURES, ONE MESSAGE

Avoiding public confusion through consistent messaging – this was the communication group’s charge.

Many patients we serve in Northwest Arkansas principally speak and read languages other than English. It was vital that all communications be shared in multiple languages: English, Spanish, and Marshallese. Recent information from the Northwest Arkansas Council’s report “Engage the Future: A Look at the Growing Diversity in Northwest Arkansas,” explains why: Northwest Arkansas’s population has diversified significantly over the last ten years. Minority populations accounted for approximately 24% of the total NWA population in 2010. In 2019, diverse peoples accounted for nearly 28% of the population, and current estimates are for diverse populations to increase to 31% by 2024.

Our Hispanic population accounts for approximately 17% of the population, and while our Marshallese population does not account for a significant percentage of the population (about 15,000 people), Northwest Arkansas is home to the largest concentration of Marshallese (people from the Marshall Islands in the central Pacific) outside their island chain.

We began the COVID-19 communications journey in standard ways: Our first regional message was a Joint Statement released March 18, 2020; this was the day Northwest Arkansas’s first COVID-19 case was identified. Simultaneous with the statement’s release, health care organizations rushed to increase testing capacity. So, our next move was to create uniform instructions for testing site workers and provide the public with testing locations.

ether tems Work Tog ) ansas Health Sys virus (COVID-19 Northwest Ark ing the Coronaappropriate screening and testing tain Con g, atin on being informed Screening, Tre

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2020) nsas (March 30, prov iders : nal health care from your regio hwest Health nsas community st Arkansas , Nort lth Care System Northwest Arka Hea Mercy Northwe A mes sage to the Northwest, Community Clinic, S Northwest and the Veterans ren’s ical Center, UAM Arkansas Child Med onal Regi ton System, Was hing ening, te efforts in scre of the Ozarks. work and coordina late in our community cies continue to and state agen 9) as ques tions continue to circu care providers ID-1 (COV rus The area health navi aining the coro ds. treating and cont ia, employers, family and frien med are concerned d below. If you - from patients, e and call in the region liste g opportunities se utiliz e our onlin yourself and ID-19 screenin COV gh that you plea ral enou seve ze ss. To protect hasi There are we cannot emp 9 is a contact illne 9, ID-1 tion where staff ID-1 COV loca COV s. te that you have of our location ed in an appropria visitor policies and one to test be ing you com ired options befo re tightened our if testing is requ nt patient nt (PPE). We have important that ective equipme our teams, it is poning non-urge prot post and onal also are pers te on. We limit exposure have the appropria for this very reas y precautions to e are necessar ss into facilities are limiting acce al care visits. Thes encouraging virtu procedures and . nts and staff * protect our patie ************ ible. ************ safest way poss ************ patients in the ting to the ************ ed to caring for itoring and adap , we are committ ID-19 and are mon th care providers COV ecting our t heal prot n’s abou e with regio g mor As the poss ible. Alon ic. As we , we are learning way st publ ther the safe toge to the ion in In our work patients date informat to care for our full impact of t accurate, up to evolving situation gh the spread and s and protocols provide the mos response. Thou are working to esse caregivers, we inue to adjust our know and modifying our proc do ledge, we will cont gain new know sed on what we focu are we , own COVID-19 is unkn s to opriate measure accordingly. proactive and appr have provided ene. Remember, and local leaders distancing and good hand hygi rnor Hutchins on the spread in social ain ding cont inclu To Arkansas Gove 9, ng).

ID-1 e and spread of COV mus t stay hom (coughing/sneezi slow down the act and droplets s. This does not mean that you ad through cont eline sens e: COVID-19 is spre follow CDC guid nsas , we mus t t use our common Arka mus st We d. hwe Nort ide worl act with the outs avoid any cont

Northwest Arka

•

Cont act Martine Pollard martine.pollar d@mercy.net 501-350-8001 **** ******** **** * JOIN T STATEME NT Sent on behalf of the Northwes t Arkansas health care providers

Practice Social Distancing: • Avoid grou ps of • Keep six feet 10 or more peoples, particula rly in close prox of distance from imity others. COVID-1 prevent body or 9 is a contact illne clothes contact. ss. Keeping dista A six-foot dista coughed or snee nce nce from others zed helps prevent bein will virus to thos e who on and will help you to stay well g and prevent you can become very from carrying the ill.

As a citiz en of this commun ity, what can you do?

• Practice Goo d Social Distanci ng and Common Sense • Practice Goo d Hygiene: • Was h your Hands, Was h your Hands, Was h your • Avoid touc hing your eyes Hands , nose, and mou th • Self-Quarantine: • If you exhi bit symptoms, stay home and avoi home d contact with others in the com • If you have munity or at symptoms cont act your screened for sym ptoms and rece health care provider either onlin • If you expe ive any necessar e or by phone rience extreme y next steps to be symptoms inclu symptoms plea ding high fever, shor se seek immedia tnes te medical atte ntion by contactin s of breath, or other • Stay Info rmed: g your health care provider • Visit the Cent ers for Department (ADH Disease Control and Preventio n (CDC ) and Arka • Tune into Gove ) websites for information and nsas State Hea lth changes in reco rnor Hutchins on’s mmendations daily briefing with doing an excellent expert phys ician job of commun • Visit our web s on his staff. He icating. sites and follow is our social med • Listen to our ia on local upda phys icians and tes the mes sages they are providing As health care providers , we are are able, we enco part urage you to supp ners in the community and our are developing ort our local busi com ways for you to ness es. We have munity’s vitality. For thos e that safely acquire important time great and crea their goods and tive business es to find ways to products . Ther who shop local and e has never been to support the a more business es in our Again, if you are community. experiencing sym ptoms, please CALL your loca l provider to dete rmine next step s.

Above: The first project of the communications coalition was to issue a Joint Statement as COVID-19 first reached the region.

Below: The Stay Safe, Stay Strong PSA campaign utilizes messaging in three languages: English, Spanish, and Marshallese. This helps reach varying cultures served by health care teams throughout northwest Arkansas.

ARKANSAS HOSPITALS | SPRING 2021 11

Anti-masking became a 'thing.' ...We needed to strengthen our message, and fast.

As the area’s larger employers sought guidance for employees testing positive for or exposed to COVID-19, we received calls from owners of small businesses and non-profit organizations who were also anxious about their COVID-19 requirements.

It's said that necessity is the mother of invention. We developed regional COVID-19 Employer Guidance (complete with scripting for health care teams who received phone calls asking for help). The guidance brought public health strategies to the business community, and new community relationships were a positive result.

Notably, we connected with numerous small businesses – many Hispanic- or Marshallese-owned – that wanted to work with the health care community to receive regular COVID-19 updates.

Northwest Arkansas’s health care voice became known as the trusted COVID-19 health resource. But again, operating on the fly, it felt like we were playing whacka-mole, mainly developing resource tools to meet this need and that need as they cropped up.

12 SPRING 2021 | ARKANSAS HOSPITALS

WHEN CLEAR MESSAGING IS UNHEEDED

Though we were circulating very pointed communications aimed at masking, social distancing, and handwashing, it didn’t take long to know more was needed. In Northwest Arkansas, as in many areas of the country, it was visibly apparent that many were not hearing/heeding public health messages. Anti-masking became a “thing,” and we knew it would likely lead to a surge in new cases.

We needed to strengthen our message, and fast: We needed a fullblown PSA campaign. It had to be regionally focused, consistent, multifaceted, and multi-lingual. It needed to say, loud and clear: The virus is serious, and every person is needed to control its spread. Messages promoting good public health practices, recorded by familiar local influencers in familiar places, could help people connect personally to the messages and perhaps yield more compliance.

Lacking any funding source, trusted colleagues barreled forward, donating talent and expertise. As we outlined the COVID-19 communications plan, we knew it would need to both capture immediate attention and build public trust over many months.

Here’s what we kept in mind: • Design a campaign to encompass any/every phase of the COVID-19 pandemic.

• Develop strategies not locked to any specific instance or timeframe, knowing that changes are inevitable as more is learned about the virus.

• Make certain the campaign reflects the spirit of the region.

• Connect the campaign to all audiences and to all who live in Northwest Arkansas utilizing consistent, solid messages from the health care community.

”SAFE AND STRONG”

Thus, in April 2020, “Safe and Strong” was born. It’s a phrase that captures the spirit of the region. As Northwest

Arkansas was not yet experiencing a significant surge, we considered it a “proactive” campaign, with key messages we hoped would help stem the impact of the deadly virus: Practice social distancing, wash your hands often, clean high touch surfaces, wear a mask covering your mouth and nose.

We developed every message based on health care’s bottom line – help prevent community spread and keep hospital capacity from becoming strained. These messages have not wavered over the months.

A serious new concern in the spring of last year was the number of COVID-positive patients coming from our minority communities, specifically the Hispanic and Marshallese cultures.

We began leaning into those new connections with cultural community leaders to create the most precise messages possible.

An instrumental partner in our region’s outreach to the Marshallese, UAMS-NW is a member of the NWA Council Health Care Transformation Division and a part of the communications collaborative.

A series of flyers in English, Spanish, and Marshallese, including this one on mobile testing for COVID-19 at UAMS-NW, are included in the PSA campaign. Community businesses post messages from the PSA kit to keep their customers informed.

(Continued on page 15)

ARKANSAS HOSPITALS | SPRING 2021 13

Relationships: Our North Star

N

orthwest Arkansas’s driving force in understanding our region’s needs includes building strong community relationships and meeting people where they are. While COVID-19 shines a bright light on inequities, it also reveals efforts addressing those inequities, helping pave a way for people and communities to thrive.

Northwest Arkansas’s coordinated COVID-19 efforts and messaging are the result of strong professional relationships among the region’s health systems and the Northwest Arkansas Council (and its Health Care Transformation Division). The Division is relatively new to the Council. It was created to facilitate the health care community’s coming together to address current and future health needs of the region.

That facilitation was launched when the Council hosted the region’s first-ever health care summit in April 2016.

Fast forward to July 2019, when the Division was officially established. Its first tasks?

Implement recommendations of a study to increase access to high-quality specialty care, increase medical research and development, and expand the region’s health care education offerings. In teeing up implementation of those recommendations, the group was able to quickly pivot its focus to address the COVID-19 crisis.

The Division was the initial setting of the region’s COVID-19 efforts, but it is the extensive relationships and ties among the community, nonprofits, businesses, community leaders, organizers and implementers that enabled the work to start, move forward, and persevere.

Recognizing the importance of relationships in any communication and outreach strategy, the work is guided by these voices and a deep understanding of regional community needs. Tools developed from necessity allow us to keep on innovating; established outreach initiatives are evolving, and we continue to connect with organizations carrying important messages by trusted messengers.

Notable during COVID-19 are new affiliations with those often disconnected from traditional communication sources, including ethnically diverse small businesses, culturally diverse populations, and communities with technological barriers. Whether it be developing trilingual COVID-19 resources or implementing efforts to test and vaccinate within the hearts of communities, our mission-driven approach to building strong communities and meeting people where they are is always our North Star. It helps us save lives and contain COVID-19 through outreach and communications.

The work is guided by these voices and a deep understanding of regional community needs.

14 SPRING 2021 | ARKANSAS HOSPITALS

(Continued from page 13) People from its Office of Community Health and Research have deep ties with the Marshallese community developed over the past decade. With their help and that of community leaders, our team was able to create useful educational messages and post them where they would most likely be viewed.

Facebook Live and YouTube sessions featured UAMS physician Dr. Sheldon Riklon, one of only two Marshallese/U.S.-accredited physicians in the nation. UAMS-NW also created several COVID-19 educational posters in multiple languages that are now incorporated into the PSA campaign materials.

Along with the Marshallese, in the spring of 2020 our Hispanic population was being significantly affected by COVID-19. Through established health care outreach programs, representatives of the Hispanic community worked with us to create educational messages delivered by trusted messengers through a number of platforms. Again, these followed the campaign’s consistent message: Safe and Strong.

OVERTAKEN

Compared to the rest of Arkansas, case counts in our region were slow to develop. But by late April and early May, as the rest of the state was carefully reopening, our regional patient count began to rise.

Elective surgeries and outpatient care reopened, compounding care challenges and leading to congestion and stress on health care resources.

Anti-masking remained a significant problem. Though we made every effort to influence the public and slow the spread of the virus, by early summer our region was labeled a national “hot spot.” The Centers for

Disease Control and Prevention (CDC) put a field team in our area tasked with researching and understanding factors leading to the spread.

Some of the CDC’s findings suggested that language and cultural barriers could be a contributing factor to our high number of cases, noting that our Hispanic and Marshallese populations were disproportionately affected by the virus.

They suggested that our early efforts at sharing critical messaging weren’t reaching everyone. The CDC applauded our extensive efforts toward multi-cultural education, and team members noted that they had not seen another area in the country as dedicated to communicating in such an interdisciplinary way. But clearly, we had to do more.

The public wanted to know and understand area specifics.

UNDAUNTED

Trusting that the PSA campaign was robust and sound, the NWA Council decided to expand its scope and reach by funding targeted media buys.

Thus, multimedia communication became an important tool in our toolbox. Airing our PSAs on TV, radio, through outdoor billboards, print, and online, we tapped English-, Spanish-, and Marshallese-language networks.

The Council, through its own resources, helped refine our original educational tools and created a centralized location where people could find a multitude of COVID-19 response resources. You can find that today at nwacouncil.org/ covid19/.

A PHASED EFFORT

Safe and Strong’s multimedia launch was in June 2020. That initiated Phase I of the campaign, when we supplemented media messages with frequent joint media releases, statements, and resources from health care entities, along with statewide daily COVID-19 updates.

Because June marked a harrowing upward surge in cases for our region, it became apparent that while the state’s daily virus data updates were helpful, they did not adequately tell the story of what was happening in Northwest Arkansas. The public wanted to know and understand area specifics. So, the Northwest Arkansas daily update became a new, major information resource added to the “Safe and Strong” campaign.

Our weekday updates continue today and include information about state and regional COVID-19 cases, hospitalizations, intensive care unit (ICU) utilization, ventilator usage, and updated testing resources.

When COVID-19 vaccines became a new area of focus, we incorporated broad communication on vaccination statistics as it became available.

Even with those efforts, more levels of communication were needed

ARKANSAS HOSPITALS | SPRING 2021 15

Various health care leaders and regional influencers appear in the print and video messaging series "Stay Safe, Stay Strong."

to address the rampant spread. That meant more funding. The Council’s Health Care Transformation Division asked UAMS-NW to take the lead in requesting an allocation of CARES Act funding administered by the federal government on behalf of the region.

The CDC’s spring assessment of regional cases and our early communication efforts served as a roadmap for the funding request.

The request outlined funding needs for collaboration and multi-agency coordination of COVID-19 testing, contact tracing, enhanced case management, and health education communications.

In late July 2020, UAMS-NW received funding on behalf of the Division, launching Phase II of the communications campaign. Health care professionals, along with several nonprofit partners, continued their focus on addressing disparities to help decrease the alarming number of cases in our Marshallese and Hispanic populations.

July’s baseline data indicated that approximately 45% of cumulative COVID-19 cases were occurring in the Hispanic community and 19% in the Marshallese community. By January 2021, case numbers in these populations were decreasing.

Data show that, in January, 31% of

16 SPRING 2021 | ARKANSAS HOSPITALS

cases were occurring in the Hispanic population and 8% in the Marshallese, a drop of 14% and 11% respectively.

Regional messaging and the Safe and Strong campaign were an integral part of that effort.

ADAPT AND ADOPT

Until recently, there’s been little relief in Northwest Arkansas from this horrible virus. We reached a new high in caring for hospitalized COVID-19 patients over the New Year’s holiday, and for months we have been caring for patients numbering in the hundreds both in COVID-19 units and in ICUs. In recent weeks, our COVID-19 cases have declined, and in late February we hosted, at Governor Hutchinson’s request, a mass vaccination event where 3,000 people received shots. But the end of the pandemic is not near, and the runway is not yet visible. We are making progress, but there is still much to be done as we send our messaging out to motivate social change and help bring an end to the crisis.

Having passed the pandemic’s one-year mark, we are now in Phase 5 of “Safe and Strong.” The PSA campaign’s videos, commercials, and much of our content continue to

feature local community members, organizations, and businesses doing their part to beat COVID-19. They show people leading by example, engaging in and advocating for safe practices that we know will slow the spread of the virus and its variants.

We offer our resources and tools to other hospitals and area communication groups, so you can adopt and adapt them to your own community’s needs. “Safe and Strong” addresses cultural, linguistic, socioeconomic, and geographic challenges. This has been our laser focus, and it is a strategy we’ve sought to maintain through the course of the pandemic.

Keep flying the plane. The runway is ahead. Stay Safe, Stay Strong.

Martine Pollard serves as Executive Director, Community and Public Relations at Mercy Northwest Arkansas in Rogers. Since the beginning of the pandemic, she also serves as the Northwest Arkansas health care community’s liaison and leads Northwest Arkansas’s “Safe and Strong” joint communications effort about which this article is written. You may reach her at Martine.Pollard@ mercy.net.

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Effective Spring 2021, hospitals must electronically Effective Spring 2021, send admission, and transfers (ADTs) to Effective Spring 2021,discharge hospitals must electronically

Effective Spring 2021, hospitals must electronically send admission, discharge and transfers (ADTs) to Effective Spring 2021, hospitals must electronically send discharge andproviders. transfers (ADTs) community sendadmission, admission, discharge and transfers (ADTs) toto to send admission, discharge and transfers (ADTs) Effective Spring 2021,and hospitals must electronically send admission, discharge transfers (ADTs) to providers. community providers. community community providers. providers. community send admission, discharge and transfers (ADTs) to providers. community SHARE is ready and prepared to help participants community providers.

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Lifesaving mAbs:

Monoclonal Antibody Treatment Fights COVID-19 in South Arkansas

By Alex Bennett

M

onoclonal antibody therapy can help speed the recovery of high-risk patients testing positive for COVID-19. Medical Center of South Arkansas (MCSA) began using monoclonal antibody (mAb) infusions to treat COVID-19positive patients on December 8, 2020. These infusions treat confirmed COVID-19 patients who are at high risk of disease progression and hospitalization, with the intention of helping them recover without requiring hospitalization or trips to the emergency room. High-risk patients include anyone over age 65 and people with underlying health conditions.

The treatments are given in an outpatient setting at MCSA One Day Surgery and take around two and a half hours from start to finish. Like many hospitals across the state, MCSA received the mAbs free of cost from the Arkansas Department of Health. Upon confirmation of the infusions’ arrival, MCSA began development of a plan for administering them and communicating the treatment’s benefits to area physicians and the community.

18 SPRING 2021 | ARKANSAS HOSPITALS

Stacy Wagnon, RN, and Morgan Nash, RN, are MCSA’s infusion nurses for mAb treatments.

REDUCING HOSPITALIZATIONS, SAVING LIVES

MCSA Chief Nursing Officer Amy Triplet led the charge to form an implementation plan. It made sense to administer the infusions through a modified unit in MCSA’s One Day Surgery department.

Director of MCSA One Day Surgery Semekia Amerison quickly converted the area to accommodate COVID-19-positive patients in an environment safe for staff and patients, and One Day Surgery nurses Stacy Wagnon, RN, and Morgan Nash, RN, stepped up to serve as antibody infusion nurses.

Wagnon says she “feels a calling to care for these patients” because she wishes this treatment had been available when one of her family members fell ill with COVID-19. She believes the infusions could have made a major difference in that loved one’s recovery.

“Through MCSA’s participation in the monoclonal antibody treatment program, we believe we have been able to save many lives in our community and reduce the number of hospitalizations in south Arkansas,” Triplet says.

COMMUNITY BUY-IN

After developing and implementing MCSA’s mAb administration plan, the team turned toward its communication efforts.

Because patients look to their own physicians for treatment guidance, local physicians are our most valuable resource in the fight against COVID-19. Educating local physicians on the benefits of mAb treatment became the team’s top priority.

This clip from a KTVE newscast features One Day Surgery Director Semekia Amerison, RN, BSN, discussing mAb use at MCSA. (Courtesy KTVE, the NBC affiliate serving the El Dorado, Arkansas and Monroe/West Monroe, Louisiana area.)

ARKANSAS HOSPITALS | SPRING 2021 19

Medical staff were notified via email about the benefits this lifesaving treatment could offer their early-onset COVID-19-positive patients. The email also outlined the procedure and guidelines for ordering the mAb treatment.

Next, team members began calling all surrounding area clinics to let their medical teams know we were offering mAb treatments and how their patients could benefit.

After offering information to both physicians and clinics, efforts turned to community education. Throughout the course of the COVID-19 pandemic, community education has proven to be more important than ever. Because of social distancing requirements, MCSA has turned to virtual means to expand community education.

Amerison initiated these efforts with virtual presentations to local civic groups and news stations. She outlined information about mAb treatment and how the infusions are given. Facebook proved to be a popular resource when connecting with the public. Facebook

reporting shows that MCSA’s educational posts have reached more than 35,000 people.

REGIONAL RESULTS

Due to our education efforts, MCSA began receiving referrals from all over southern Arkansas and northern Louisiana. Shortly after we began offering the infusions, we saw a reduction in hospitalization rates.

Members of our infusion team call each patient after their treatment to follow up, noting their progress and checking to see how they are feeling.

Patients treated with antibody infusion report feeling better after 24 hours, and not one of them has been hospitalized due to COVID-19 complications.

“I believe this drug has been extremely effective in treating COVID-19 patients,” Nash says. “I call to check on our patients a couple of days after the infusion. It makes me feel good to hear their recovery stories and know that I had a part in their recovery.”

COVID-19 continues to present many challenges to health care organizations around the nation.

Treatments like the COVID-19 mAb infusions can make a significant impact on the reduction of COVID-19related deaths and hospitalizations, and they are helping ease the strain on health care systems.

Alex Bennett is the Executive Director of Business Development at Medical Center of South Arkansas.

Originally from Hot Springs, Arkansas, Bennett attended the University of Central Arkansas and moved to El Dorado in 2012. As the Executive Director of Business Development, she assumes many roles including Business Development, Marketing Director, Physician Liaison, Recruitment, and Volunteer Director.

For more information on the Medical Center of South Arkansas, visit TheMedCenter.net.

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COVID-19 “Long-Hauler” Patients Search for Answers and Help

By Rick Kushman, courtesy of UC Davis Health

I

f you survive COVID-19, you may have something else to fear, and it has nothing to do with how sick you were.

For some people – and there seems to be no consistent reason – symptoms can last and last, sometimes for months. The name many of these patients call themselves is “long-haulers,” but it does not begin to describe the confusion, anxiety, and distress that long-term COVID-19 patients endure.

“It’s scary for them,” says Nicholas Kenyon, a University of California, Davis Health (UC Davis Health) professor and leading pulmonary and critical care expert. “They want to know, ‘Why am I still out of breath? Why am I still tired and coughing after months? Am I ever going to get better?’”

The answer for them is not clear, and it is certainly not simple.

That’s because even defining the problem is not simple.

There are no precise statistics on the number of long-haul patients – people who, in theory, have recovered from the worst impacts of the coronavirus, tested negative, but still have symptoms that can last for weeks or months. The Journal of the American Medical Association in a recent article, as well as a study from a team of British scientists, estimate about 10% of COVID-19 patients become longhaulers. That’s in line with what UC Davis Health is seeing, Kenyon says.

But it’s hard to quantify because it’s hard to define the length of time that lingering symptoms fit the longhaul COVID-19 category.

“Even after a month, it gets frightening,” Kenyon said.

“People ask, ‘What’s wrong with me?’”

ARKANSAS HOSPITALS | SPRING 2021 23

Teams of experts at UC Davis Health’s new PostCOVID-19 Clinic will work to help patients who battle complex, long-lasting symptoms.

NO LIMITS TO THOSE AFFECTED

Long-term COVID-19 appears to affect every kind of patient – from people who were hospitalized with severe COVID-19 to those with very mild bouts who recovered at home.

It appears in regions with both high rates and low rates of COVID-19 infections. It attacks people who were battling other conditions before contracting COVID-19 and people who were completely healthy. And it hits both the old and the young.

“We’ve seen this in patients across the gamut, and there do not appear to be any clear connections in the cause,” Kenyon says. “What’s new is this is affecting some people who are quite young who were very healthy and never had other illnesses.”

It is not uncommon, Kenyon says, for patients hospitalized for a long time – whatever the reason – to take months to get back to feeling normal.

But even those [long-hospitalized] COVID-19 patients are inconsistent.

Most recover on a steady, if sometimes slow, upward line, but some have symptoms that persist for months.

“We have experience helping people who were hospitalized with other severe viral infections,” he says, “but this disease is so new, there is still much to learn. We don’t know why a few hospitalized patients continue to have symptoms and others don’t.

We aren’t even exactly clear what all the symptoms are.”

24 SPRING 2021 | ARKANSAS HOSPITALS

What’s new is this is affecting some people who are quite young who were very healthy and never had other illnesses.

COMMON SYMPTOMS OF LONG-HAUL COVID-19

The list of symptoms is long, wide, and inconsistent. For some people, they are nothing like the original symptoms they had when they first were infected by COVID-19. The most common include: • Coughing.

• Ongoing, sometimes debilitating, fatigue.

• Body aches.

• Joint pain.

• Shortness of breath.

• Loss of taste and smell – even if this did not occur during the height of their illness.

• Difficulty sleeping.

• Headaches.

• Brain fog.

That last one is among the most confounding. Patients report being unusually forgetful, confused, or unable to even concentrate enough to watch TV. “That sort of brain fog can happen to people who were in an intensive care unit for a length of time, but it is relatively rare,” Kenyon says. “But this is happening to all sorts of patients, including people who had mild cases and were not hospitalized.”

Symptoms for long-haulers are not uniform. Some report severe chest pain along with more general body aches. Others have chills and sweats or gastrointestinal issues. Some people have reported feeling better for days or even weeks, then relapsing.

For others, it’s a case of just not feeling like themselves.

“There are patients who can go for a run and test completely normal,” Kenyon says. “But they still don’t feel right. They aren’t back to their old selves, but we can’t fully define what’s wrong. Telling a patient who feels bad that they are fine and there is nothing we can identify is not a decent answer for them, or for us.”

TRYING TO EXPLAIN LONG-HAUL COVID-19

The problem for patients and experts trying to help is the same one that physicians and infectious disease experts face with COVID-19 in general – it’s so new that science is only beginning to grasp it. And long-haulers have only

recently gotten the attention of some experts who were first engaged with trying to slow the pandemic or care for dangerously ill patients.

The vast majority of long-haulers test negative for COVID-19, and there is no specific test to give them for lasting symptoms of the coronavirus, says Nam Tran, Associate Clinical Professor of Pathology and Laboratory Medicine and Senior Director of Clinical Pathology in charge of COVID-19 testing at UC Davis Health.

“Unfortunately, we don’t know enough about the virus to test for its lingering effects,” Tran says. “There are questions about why their fatigue goes on and on, and science just hasn’t solved them yet. We’re all learning in real time.”

The most common theories about long-term COVID-19 patients include the hypotheses that the virus remains in their bodies in some small form, or that their immune systems continue to overreact even though the infection has passed.

“The idea that the virus is somehow persisting has been discussed,” Kenyon says. “This doesn’t mean the virus is growing or that we can test for it, but this might mean their bodies are reacting to it, or it’s still triggering ongoing inflammation.”

Some infectious disease experts, including Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, have speculated that long-term COVID-19 might be a form of what is called chronic fatigue syndrome, or myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS).

Unfortunately for long-haulers, ME/CFS is not well understood, either.

WHAT IS BEING DONE TO HELP?

As with many other COVID-19 issues, it’s hard just knowing how long some of the symptoms might last when the disease was identified [just over a year] ago.

Learning how to treat these patients also requires time.

“First, we have to discover what we can about the disease and how to treat it,” Kenyon says. “That takes time and experience. Then we all have to share the information with other physicians and

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Many long-haul COVID-19 patients battle exhaustion and a range of other symptoms.

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There are questions about why their fatigue goes on and on, and science just hasn’t solved them yet.

We’re all learning in real time. the public. We don’t have that system of sharing in place yet for long-haulers.”

Early in the pandemic, pulmonary care chiefs around the U.S. gathered virtually on Sunday evenings to talk about caring for patients and to share information to help each other progress. Kenyon says he’d like to see something like that resume to discuss caring for long-term COVID-19 patients.

“It may not seem to be as much of an emergency as in the first days of the pandemic, but this is just as important,” he says. “Because of the pandemic, we don’t have some of our usual routes of communication, like in-person meetings and conferences.”

Also, because the disease is so new, much of the information about long-haul COVID-19 cases and care is anecdotal.

That is changing, however, and UC Davis Health is working to bring its expertise together to help patients. [In fact, a new Post-COVID-19 Clinic was recently established by UC Davis Health to care specifically for long-haul patients.]

“These people need our help,” Kenyon says. “We don’t want anyone to have to go step-by-step through each symptom or to go through a list of referrals to find out what’s happening to them. We are uniquely set up to care for these patients, and we will.”

Article shared courtesy of University of California, Davis Health, Sacramento, California. Used with permission.

ARKANSAS HOSPITALS | SPRING 2021 27

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28 SPRING 2021 | ARKANSAS HOSPITALS

COACH'S PLAYBOOK

A Crisis in American Health Care (and No, It Isn’t COVID-19!)

by Kay Kendall, special to Arkansas Hospitals magazine It’s November 2020, and you’re the parents of a beautiful, 5-year-old daughter.

Less than 15 hours after she tests positive for COVID-19 and is sent home from the ER, she’s dead.

Did she die from COVID-19, or because her skin was black? You’ll never know.

(This is just one of many similar incidents reported by media outlets over the past year.)

A NEW LOOK AT DISPARITIES

The disparities in health care and health outcomes have been known for decades, but nowhere have they been more evident than during this pandemic.

Rather than focus on differences as they apply to infection and mortality rates, it’s time we take a broader, more strategic, longer-reaching look at the social determinants of health.

Dr. Donald Berwick, known to many as a pioneer in health care’s modern qualitycare movement, refers to these disparities as the moral determinants of health.1 “Attacking racism and other social determinants of health is motivated by an embrace of the moral determinants of health,” Berwick says. “These include, most crucially, a strong sense of social solidarity in the U.S. ‘Solidarity’ would mean that individuals in the U.S. legitimately and properly can depend on each other for helping to secure the basic

circumstances of healthy lives, no less than they depend legitimately on each other to secure the nation’s defense.

If that were the moral imperative, government – the primary expression of shared responsibility – would defend and improve health just as energetically as it defends territorial integrity.”

Experts generally agree that four factors (and their weighted percentages) contribute to health: • Clinical Care Factors, including access to care, quality of care, and safe care. These contribute about 20% toward a person’s health and well-being.

• Social and Economic Factors, including food security or insecurity, adequacy of housing and/or lack of housing (homelessness), employment security, adequacy of income, level of education, and community safety. These contribute about 40% toward a person’s health and well-being.

• Behavioral Factors, including choice and quality of diet, amount of physical exercise, drug use, and mental health.

These determine about 20% of a person’s health and well-being.

• Environmental Factors, including quality and availability of safe water and clean air, and availability of safe transportation. These comprise the remaining 20%.

In his seminal opinion piece, “The Moral Determinants of Health,” Berwick paints a compelling picture of how these moral determinants combine with startling effect on life expectancy. “From midtown Manhattan to the South Bronx in New York City, life expectancy declines by 10 years,” he says. “[That’s] six months for every minute on the subway. Between the Chicago Loop and [the] west side of the city, the difference in life expectancy is 16 years. At a population level, no existing or conceivable medical intervention comes within an order of magnitude of the effect of place on health.”

Editor’s Note: This winter, Kay Kendall interviewed Dr. Donald Berwick, Dr. Randy Oostra, and Dr. David Ansell to get their input on one of today’s most significant – and most frustrating – public health challenges: the ever-widening gap in health equity, and how social determinants play into every neighborhood’s health and its residents’ longevity. She asked these preeminent health leaders for their ideas on bringing health equity home to individual communities, and how hospitals can play a role in improving health inequities. Here is the result of those interviews.

ARKANSAS HOSPITALS | SPRING 2021 29

WHERE DOES ARKANSAS STAND?

Arkansas Department of Health data indicate that both life expectancy and infant mortality are alarmingly affected by the county in which Arkansans live. This backs up Berwick’s claim – location, or where we live, is the major determinant of health.

It is no secret that Arkansas is one of the least healthy states in the U.S. It has the sixth-highest poverty rate

in the nation, and it is ranked 42nd in level of education. And in terms of overall health, in 2019 (the last year for which reported data are available), Arkansas ranked 48th in the nation.

Only Louisiana and Mississippi were ranked lower.

This is not an insurmountable problem. Leaders of multiple health systems are working every day with their community leaders to form powerful coalitions addressing each of the factors impacting community health.

For example, Toledo, Ohio’s Root Cause Coalition is chaired by Dr. Randy Oostra, President and CEO of ProMedica, a non-profit health care system with locations in northwest Ohio and southeast Michigan.2 In the 10 years since ProMedica developed its strategic plan to address the social determinants of health, huge strides have been made. The coalition has conducted 971,000 food screenings and 118,030 full screenings over 10 domains. It has embedded numerous solutions for providing food to those in the community suffering from food insecurity. It has provided financial coaching to community residents and access to low-interest funding so entrepreneurs can create businesses and jobs. I urge you to listen to Dr. Oostra in his powerful TED talk.3 In my interview with Dr. David Ansell, he described forming West Side United as a coalition of six local hospitals and a variety of community organizations, faithbased institutions, and businesses to focus on four impact areas: Economic Vitality, Education, Health & Healthcare, and Neighborhood & Physical Environment.4 The group developed a scorecard with measures for each of these areas so that progress can be monitored, documented, and shared with neighborhood residents. Other communities might utilize that scoreboard as they try to make related impacts.5 Similar to Richard Rothstein’s observations in his book The Color of Law: A Forgotten History of How Our Government Segregated America, Dr. Ansell observes that, “Life opportunities are limited when you’re surrounded by poverty.” Rothstein notes longitudinal studies reporting that children born into poverty are likely to be even more impoverished than their parents when they become adults.6

RACISM: A PUBLIC HEALTH CRISIS

Many medical schools are declaring racism as a public health crisis.7 Following the Memorial Day 2020 killing of George Floyd in Minneapolis, the states of Michigan, Nevada, Wisconsin, and Colorado acknowledged and proclaimed 30 SPRING 2021 | ARKANSAS HOSPITALS

FOR YOUR REFERENCE SHELF THE IHI EQUITY COLLABORATIVE

A treasure trove of information with practical guides to address key areas to improving health care equity: • Make Equity a Strategic Priority.

• Build Infrastructure to Support Health Equity.

• Address the Multiple Determinants of Health.

• Eliminate Racism and Other Forms of Oppression.

• Partner with the Community.

Also included are many additional resources and lessons learned from the health care organizations that have joined the IHI Equity Collaborative. www.ihi.org/Engage/Initiatives/ Pursuing-Equity/Pages/Resources. aspx

THE ROOT CAUSE COALITION

From the report, The Status of Health Care Equity, to a series of webinars with presentations by executives of health care organizations on the journey to improve equity in health care, this site is another source of information to help you explore this critical topic for your own organization. w w w. ro o t c a u s e c o a l i t i o n . o rg / webinars/

THE DEMOCRACY COLLABORATIVE

The Healthcare Anchor Network offers a playbook for how health systems can collaborate to improve community well-being by building inclusive and sustainable local economies. democracycollaborative.org/learn/ publication/anchor-mission-playbook

Donald M. Berwick is the world’s foremost scholar, teacher, and advocate for the continual improvement of health care systems. He is a pediatrician and a longstanding member of the faculty of Harvard Medical School. He founded and led the Institute for Healthcare Improvement, now the leading global nonprofit organization in its field. Appointed by President Barack Obama as Administrator of the Centers for Medicare and Medicaid Services (CMS), he served in that role in 2010 and 2011. He has counseled governments, clinical leaders, and executives in dozens of nations. He is an elected Member of the National Academy of Medicine and the American Philosophical Society.

He is the recipient of numerous awards, including the Heinz Award for Public Policy, the Award of Honor of the American Hospital Association, and the Gustav Leinhard Award from the Institute of Medicine. For his work with the British National Health Service, in 2005 Her Majesty Queen Elizabeth II appointed him Honourary Knight Commander of the British Empire, the highest honor awarded by the United Kingdom to a non-British subject.

Randy Oostra is the President and Chief Executive Officer of ProMedica, a not-for-profit, mission-based, integrated health and well-being organization headquartered in Toledo, Ohio.

Oostra is regarded as one of the nation’s top leaders in health care and has earned recognition as one of Modern Healthcare’s 100 Most Influential People in Healthcare and Becker's Healthcare's 100 Great Leaders in Healthcare. He has a strong commitment to the health care industry and community, and he serves on the board of trustees of the following national organizations: Local Initiatives Support Corporation (LISC), American Hospital Association, Health Research and Educational Trust, and The Root Cause Coalition, which ProMedica founded.

David Ansell, MD, MPH, is the Michael E. Kelly Presidential Professor of Internal Medicine and Senior Vice President/Associate Provost for Community Health Equity at Rush University Medical Center in Chicago. He is a 1978 graduate of SUNY Upstate Medical College. He did his medical training at Cook County Hospital in Chicago, and he spent 13 years at Cook County as an attending physician.

He ultimately was appointed Chief of the Division of General Internal Medicine at Cook County Hospital.

From 1995 to 2005, he was Chairman of Internal Medicine at Mount Sinai Chicago. He was recruited to Rush University Medical Center as its inaugural Chief Medical Officer in 2005, a position he held until 2015. His research and advocacy focus on eliminating health care inequities. In 2011 he published County: Life, Death and Politics at Chicago’s Public Hospital, a memoir of his times at County Hospital. His latest book, The Death Gap: How Inequality Kills, was published in 2017.

ARKANSAS HOSPITALS | SPRING 2021 31

racism as a public health crisis. 8 Could racism be contributing to the health disparities in Arkansas communities? How would you know?

Many great resources are publicly available at no cost (see sidebar), but I asked Drs. Berwick, Oostra, and Ansell what specific actions individual hospitals and health systems can take to address racism, social inequities, and public health improvement.

Here are their recommendations: • Discuss racism, social inequities, and social determinants of health with your board members.

They are likely to include constituents represented by all four areas of impact.

• Set ambitious goals, publicize them, and post your progress toward achieving them with data segmented by ethnicity, gender, household income (or poverty level), and average levels of education.

Consider breaking the data down by county or by zip code so communities can chart their progress.

• Remember to canvass your own employees.

How many of them suffer from food insecurity, homelessness, or other factors impacting their health? You might be surprised, and again, your board will want to address these issues.

• Reduce your carbon footprint. It’s good for the planet, good for creating healthier neighborhood environments, and it can be surprisingly good for your business.

• Join one of the latest collaboratives, such as the Institute for Healthcare Improvement’s “Pursuing Equity Learning and Action Network,” 9 or Arkansas’s own “Healthy Active Arkansas.”10 What first steps will you take?

The team at BaldrigeCoach would be glad to help guide your hospital’s quest for process improvement.

As CEO and Principal of BaldrigeCoach, Kay Kendall coaches organizations on their paths to performance excellence using the Malcolm Baldrige National Quality Award Criteria as a framework.

Her team, working with health care and other organizations, has mentored 24 National Quality Award recipients.

In each edition of Arkansas Hospitals, Kay offers readers quality improvement tips from her coaching playbook.

Contact Kay at 972.489.3611 or Kay@Baldrige-Coach.com.

This model from America’s Health Rankings® is based upon the World Health Organization’s definition of health: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”The model includes four drivers, or determinants of health: social & economic factors, physical environment, clinical care, and behaviors, all of which influence the central model category, health outcomes.

Endnotes 1Berwick DM. The Moral Determinants of Health. JAMA. 2020;324(3):225–226. Retrieved from URL https://jamanetwork.com/journals/jama/fullarticle/2767353.

2The Root Cause Coalition: Achieving Health Equity through Cross-Sector Collaboration.

https://www.rootcausecoalition.org/.

3TEDx. (2020, August 4). Five Numbers That Could Reform Healthcare/Randy Oostra

[Video]. YouTube. https://youtu.be/JybvaX9kN0M.

4Ansell D. (2020). West Side United. Retrieved from URL https://westsideunited.org.

5Ansell D. (2020). Metrics Dashboard. West Side United. Retrieved from URL https://

westsideunited.org/our-impact/metrics-dashboard/.

6Goudie C, Markoff B, Fagg J. (2019, November 20). The Challenge to Cut Chicago30-

Year Life Expectancy Gap in Half by 2030. [Video and Print] WLS-TV. Chicago. Retrieved from URL https://abc7chicago.com/health/the-challenge-to-cut-chicagos-30-year-lifeexpectancy-gap-in-half-by-2030/5710399/.

7Cornell Health. (2021). Racism as a Public Health Crisis. Campus Leadership & Health

Campaigns. Retrieved from URL https://health.cornell.edu/initiatives/skorton-center/ racism-public-health-crisis.

8Kaur H. and Mitchell S. (2020, August 14). States are Calling Racism a Public Health

Crisis. Here’s What that Means. [Video and Print] CNN Health. New York. Retrieved from URL https://www.cnn.com/2020/08/14/health/states-racism-public-health-crisis-trnd/ index.html.

9Institute for Healthcare Improvement. (2021). Pursuing Equity Learning and Action

Network. Initiatives: Pursuing Equity. Retrieved from URL http://www.ihi.org/Engage/ Initiatives/Pursuing-Equity/Pages/default.aspx.

10Healthy Active Arkansas. (2021). Healthy Active Arkansas: A 10-Year Plan for Arkansas.

Framework. Retrieved from URL https://healthyactive.org.

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34 SPRING 2021 | ARKANSAS HOSPITALS

LEADER PROFILE

Vince Leist

Planning it Through, Together

By Nancy Robertson

E

very hospital is beloved within its community, but hospitals that serve rural areas perhaps receive an extra measure of open appreciation just for reliably being there. And the leaders who serve them are constantly on the lookout for new ways to serve emerging needs.

Vince Leist, President and CEO of North Arkansas Regional Medical Center (NARMC) in Harrison, is currently engaged in meeting the many challenges COVID-19 brings to the northern Arkansas region. Numerous successful projects mark NARMC’s pandemic path over the past year, and the key to this success lies in allied groups working together to help their fellow citizens.

“Editorials in the local newspapers point to ‘how organized’ North Arkansas’s COVID-19 project rollouts are,” Leist says, “and I can tell you why this is so. No matter what we’re working on, we bring together all the people who need to have a hand in the project. The groups change from project to project, but the key is to always sit down together from the very start.”

He says the first question he most often poses is, “What do you need?” That question sets the tone for a team effort from the first meeting.

We bring together all the people who need to have a hand in the project. The key is to always sit down together from the very start.

ARKANSAS HOSPITALS | SPRING 2021 35

“There are many tough issues arising because of the COVID-19 pandemic,” he says. “Like other hospitals of all sizes, the past year has brought financial struggles to our area, and to our hospital. But one unforeseen positive is the strengthening of relationships we see within the hospital and within the community. When we’re all working together toward the same goal, we see new partnerships emerge and closer working ties form.”

36 SPRING 2021 | ARKANSAS HOSPITALS

FROM THE VERY START

When COVID-19 became a known entity, leaders at NARMC immediately began prepping for what was to come.

“We ordered PPE very early, and thus had some to share when other area facilities, like the Newton County Nursing Home, found itself in need,” he says. Also ordered early: an ultralow temperature freezer (to store the vaccines that were yet to be

developed) and supplies that would be needed for NARMC to serve as a regional testing and vaccine hub.

“We purchased a previous bank building around the time the pandemic hit, and it became the perfect setting for a testing facility,” Leist says.

He credits NARMC leadership team members Chief Nursing Officer Sammie Cribbs and VP of Operations Josh Bright with laying a strong foundation for the hospital’s COVID-19 preparations.

Another group – physicians serving the hospital – had an immediate impact on preparations. “Our physician team guided every aspect of our clinical efforts at the hospital, at each of our clinics, and even at the Newton County Nursing Home,” he says. “The physicians developed a treatment protocol we utilized everywhere, and they trained all of our caregivers – even those at the ambulance station – in the proper ways of donning and doffing PPE.” Speaking of PPE, Sammie Cribbs communicated with nursing homes in the area when national supplies of PPE ran low. She made certain NARMC supplied them with the PPE needed to stay aligned with the doctors’ management and treatment protocols.

With every facility following one central clinical plan, it became easier to control viral spread. “Our physicians were integral to the assistance we offered the nursing home, an effort that became very aggressive when cases began to rise there,” Leist says.

Another coalition where groups work side-by-side is the partnership NARMC formed with the Boone County Emergency Management team, county officials, city and county law enforcement, and the Boone County health unit. This joint effort forms the backbone for regional testing and vaccination planning and delivery. “Harrison’s population is around 12,000-13,000,” Leist says.

“But the hospital has a service area of 85,000 people. Working together with both city and county officials streamlines our COVID-19 response.”

We Asked...

What’s on your music playlist?

Stevie Nicks, Moody Blues, and Joe Bonamassa

What is the best advice you were ever given? A friend gave

me a picture of a Pony Express rider moving at top speed. The image came from the Cowboy Hall of Fame museum in Oklahoma City, and the title of the image is the advice, “Never Look Back.”

Do you have a favorite movie?

Why do you like it? Not a movie

but a Prime series, “Yellowstone.” The story line, the scenery, and the acting quality make it enjoyable.

Who is someone you greatly admire, and why? My Dad. He was

Quality Care Rooted in Arkansas

hope Is The Foundation. recovery Is The Journey.

In response to the growing needs of our community, The BridgeWay has expanded its continuum of care for substance use disorders. The acute rehabilitation program will provide hope and recovery for adults struggling with substance use disorders. Led by Dr. Schay, and a Board Certified Psychiatrist and Addictionologist, the Substance Use Disorder Rehabilitation Program is for adults at risk of relapse. Rehabilitation requires the supportive structure of a 24-hour therapeutic environment.

To learn more about our continuum of care for substance use disorders, call us at 1-800-245-0011.

Physicians are on the medical staff of The BridgeWay Hospital but, with limited exceptions, are independent practitioners who are not employees or agents of The BridgeWayHospital.

The facility shall not be liable for actions or treatments provided by physicians.

a proud man of few words who worked extremely hard to make ends meet.

Dr. Schay

Medical Director Of Substance Use Disorders & Patriot Support Program

FINANCING IS THE FIRST STEP.

What would you be doing if you weren’t in health care? I have always been interested in law, perhaps a lawyer.

What do you like to do in your down time? I enjoy boating. Any

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excuse to be on the water.

What are you reading? (nonwork-related material) Hillbilly Elegy

Where would you travel if you could go anywhere? Alaska and Hawaii; I have visited both and would enjoy returning.

What’s a life-changing lesson COVID-19 has taught you? A

crisis brings out both the best and worst in people. Some rise to the occasion, and some become more problematic.

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ARKANSAS HOSPITALS | SPRING 2021 37

Testing began in March 2020. Since that time, nearly 16,000 tests have been administered. But the greatest story, Leist says, is NARMC’s service as a regional vaccine hub.

VACCINATION STATIONS

With the onset of vaccine availability, NARMC was designated as a point of distribution, or a regional vaccine

hub. “NARMC provides vaccine to other area hospitals, including Eureka Springs Hospital and Mercy Hospital Berryville,” Leist says.

Vaccination in the area began, as it did across the nation, with health care workers and those living in nursing homes; to date, more than 60% of hospital employees are fully vaccinated, as are most nursing home residents in the hospital’s service region.

Our Mission Is Twofold: 1. To improve clinical outcomes and operational efficiencies for Arkansas healthcare providers through the introduction of new technologies and innovations 2. To accelerate the development path of early stage healthcare companies by providing critical clinical engagement

Thank You To Our Provider Partners For Making Arkansas A Center For Healthcare Innovation!

www.healthtecharkansas.com To learn how your organization can participate, please contact Jeff Stinson at jeff@healthtecharkansas.com

38 SPRING 2021 | ARKANSAS HOSPITALS

The first public clinic for people aged 70+ drew 549 people, all vaccinated in about six hours, or about 100 per hour. Today, vaccination clinics targeted at various age and demographic groups, including teachers, are taking place.

“We provide what we call ‘Strike Teams’ that go out to hold targeted vaccination clinics where they’re needed,” he says. “We have sent Strike Teams to the city of Jasper, to Madison and Johnson Counties, and to nine different school campuses in the area where we vaccinated faculty and staff.” There are also three pharmacies offering age-designated, on-demand vaccinations in northern Arkansas.

“We’ll hold vaccination clinics as long as there are people to vaccinate,” Leist says. “We can distribute the vaccine as fast as we get it; our distribution plan is working well, because we have put the right people in the right places to make it happen.”

PANDEMIC LESSONS

Leist keeps coming back to all the good that has occurred amid the pandemic’s horrors. “Over and over again, we see professionals at all levels rising to the occasion for their community,” he says. “Groups of people come together to plan, to act, to follow through. We’ve seen our medical teams go into places at personal risk to care for those who are ill. We’ve seen groups form for the common good, people who are ethically and morally driven to do the right thing for their fellow humans.”

He says there’s no chapter in any administrator’s guidebook on how to manage during a pandemic. “And yet, we have managed, together. The pandemic brings to light the immeasurable value a rural hospital brings to its communities, and it constantly shows us the immeasurable good people do for one another. It’s an honor to serve here,” he says. “There is just so much good in this world.”

Statewide and National Recognition

S

erving as President and CEO of North Arkansas Regional Medical Center (NARMC) since 2011, Vincent Leist has served the hospital field for more than 30 years.

Under his leadership, NARMC has gained statewide and national recognition for care and service, including the ranking as a Top 100 Rural Community Hospital

by Chartis iVangage Health Analytics and earning dual Arkansas Governor’s Quality Achievement awards.

He was selected by the American Hospital Association to represent America’s hospitals before the House Veterans Affairs Committee in 2015, testifying to the necessity for veterans to be granted health care access in non-VA facilities.

Prior to his move to NARMC, he served for five years as Chief Operating Officer of San Antonio Community Hospital in Upland, California, where he executed programs in financial performance, operational efficiencies, cost management, and patient satisfaction positioning the facility to be recognized as a Thomson Reuters Top 100 Hospital. In addition, the facility was recognized by Thomson Reuters as one of 23 hospitals in the country demonstrating the most rapid improvement in a five-year period, earning it the Everest Award.

Named over a ten-year period to progressive management roles at Sunrise Hospital and Medical Center and Sunrise Children’s Hospital in Las Vegas, Nevada, Leist served as Administrative Director of Cardiovascular Service, Pulmonary/Respiratory Services, Assistant Vice President of Operations, Vice President of Professional Services/ Operations, and Senior Vice President of Professional Services/Operations.

His service to the health care field also includes management roles in large facilities in Oklahoma, Iowa, and Kansas.

He holds a Master of Public Administration degree from the University of Kansas and a Bachelor of Arts degree earned at Ottawa University in Ottawa, Kansas. He is a Fellow of the California Healthcare Leadership College, Berkley, and served as adjunct faculty at the University of Nevada Las Vegas, Rose State College in Midwest City, Oklahoma, and Washburn University in Topeka, Kansas. He currently serves as a member of the Arkansas Hospital Association board.

Opening its clinic in Berryville is a highlight of NARMC's service to the regional community. The hospital has a regional service population of 85,000.

ARKANSAS HOSPITALS | SPRING 2021 39

Compassion Tech:

Merging Technology, Consumerism, and the Human Connection for Health Innovation

By Andy Shin

I

n the last several decades, there have been a few times where societal shifts in direction have supported technological and business model innovations, by coalescing sector and technology firms and other stakeholders around a mutually shared goal. For example: sectors such as energy sustainability – or cleantech; finance – or fintech; and women’s health – for a specific market segment – or femtech.

The common thread among all these trends is the significant change in consumer expectations and behavior for each market sector and the different pathways for new entrants and disruptors. [Health care disruptors are companies that are shifting the health care industry by making big changes that significantly redefine the way care is delivered. That

40 SPRING 2021 | ARKANSAS HOSPITALS

can mean integrating new technologies, streamlining processes, or simply refusing to do things the way they have always been done.]

Some refer to COVID-19 as a “black swan” event – extremely rare and unpredictable – that has accelerated the use of virtual modalities in health care and in other facets of life by years, if not decades. The long-term effects likely will be an explosion of digital health applications that form the new baseline for care delivery.

Health care providers currently enjoy the lion’s share of trust via the bond between caregiver and patient. There is no doubt that a consequence of a digital revolution will result in fragmentation of that relationship and trust across many different and nontraditional settings.

How we retain and earn trust from the patient in an even more fragmented system may come down to an unexpected source of competitive advantage. The same thing that makes health care a calling more than a profession is the very thing that could unlock decades of pent-up innovation. As humans, we are hardwired to relieve suffering in others; and as health care providers, our goal is to foster healing and nurturing relationships with patients.

In health care, I see a new focus at the intersection of technology and the caregiver-patient relationship: compassion tech.

I propose defining ‘compassion tech’ generally, as knowledge-based products or services that improve the ability of users to recognize, understand, and resonate emotionally with another's concerns, distress, pain, or suffering.

DEFINING COMPASSION TECH

Although “compassion tech” does not yet define a particular category of innovations, it follows the natural evolution of health care technology. While e-health was popularized by the digitization of health care through electronic medical records, we now use “digital health” to refer to a wide range of consumer-facing and backend technologies like wearables, analytic platforms, and clinical decision support.

In a 2019 BMJ article, a group of Canadian health services researchers posited whether a “digital compassion paradox” might exist where human-to-human interaction is incompatible with emerging health care technology. What this potential paradox highlights is that digital health, to date, has largely focused on either 1) providing a lower-fidelity substitute for access to traditional in-person care, or 2) obviating the need for human interaction altogether.

Over the past decade, the health care field has dramatically increased understanding of the drivers of patient experience, clinician resilience, and the interdependence of both. Caregivers have strived to achieve relationship-based models of care to unlock greater patient satisfaction, while also working to relieve

ARKANSAS HOSPITALS | SPRING 2021 41

pain and suffering, thus reinforcing their connection to purpose. Many hospitals and health systems now list “compassion” or “compassionate care” as part of their values, mission, or strategy.

Compassion is defined as a universal expression of human connection and caring in response to distress and suffering. This is different from empathy, which is the ability to imagine oneself in another's shoes. Empathy is

how you feel; compassion is how you make others feel. To be clear, empathy helps one experience compassion.

Therefore, technologies that can help deliver compassionate care may attempt to foster empathy. But at their core, these technologies must enable action to address empathetic concern.

Thus, I propose defining “compassion tech” generally, as knowledge-based products or services that improve the ability of users to

recognize, understand, and resonate emotionally with another's concerns, distress, pain, or suffering. In the health care setting, compassion tech’s purpose should be to facilitate caregivers’ acknowledgement, motivation, and relational action to ameliorate such emotional states.

Features of compassion tech in health care delivery could shape the behavior of the caregiver, the experience of the patient, and the relationship between caregiver and patient or with family members, the extended care team, and others.

Innovative solutions could help replicate or accentuate the emotional signals and cues necessary to address the psychosocial aspects of illness, which are often diminished in virtual environments and sometimes in physical ones.

Other aspects of compassion tech could address self-reflection and unintended communication, such as facial expressions, or help uncover underlying issues such as depression, the anxiety or discomfort felt when having end-of-life discussions, and even bias.

WHERE WE NEED COMPASSION TECH

Though COVID-19 is not solely responsible for widening the compassion “divide,” the opportunity to foster more of the human connection through technological channels will be an area of intense interest. A recent McKinsey survey reported that 76% of consumers were interested in using telehealth in the future, up from 11% in 2019. Further, 57% of health care providers now view telehealth more favorably than they

... It has the promise to unleash the compassion that restores our humanity.

42 SPRING 2021 | ARKANSAS HOSPITALS

did prior to the pandemic. In other words, for providers and patients, the experience of moving care from the bedside to the screen has been less of a challenge than previously thought.

At the same time, the proliferation of telehealth, e-visits, and social distancing measures that can isolate patients from their caregivers, families, and friends comes with some potential consequences. Facial recognition tools that provide instant feedback for clinicians on their demeanor via a computer screen can be effective in sending better body language signals or detecting depression in patients. These signals and emotions otherwise would be hidden in plain sight. Artificial intelligence tools that can assist families with serious illness conversations can help demystify a still-taboo issue that affects us all.

Further, the COVID-19 pandemic has heightened our focus on disparities in health, especially in underserved communities across racial and ethnic categories. The relatively nascent field of health and technology collaborations to address disparities, equity, and the social determinants of health is coalescing around the intersection of providers, data, artificial intelligence, and community partnerships. If providing compassionate care requires a wholeperson view of health and well-being, then this is an area ripe for rapid growth.

Addressing disparities and striving for equity and inclusion can be discreet and narrowly targeted opportunities that start within the hospital walls.

For example, the startup Macro.io is working to make video conferences more “collaborative and inclusive,” a

Andy Shin wrote this blog while serving as Chief Operating Officer of the American Hospital Association Center for Health Innovation. We wish him well in his new role as Senior Vice President of Strategy at Boston's Mass General Brigham. This blog post is reprinted with permission of the American Hospital Association.

use case that could extend far beyond health care. This solution adapts a Zoom interface to visually rank order users based on speaking time and thus highlight those who might be marginalized, typically minorities, women, and introverts.

Retail, finance, energy, and other industries have catalyzed technological trends that represent dramatic shifts in how consumers and producers exchange services and ideas. But health

care has generally lagged behind when it comes to disruptive innovations.

Yet there is perhaps no other sector besides health care where human-tohuman interaction is valued as much, by patients receiving care and by caregivers whose connection to purpose is fueled by their ability to heal. This is why out of a global pandemic, one of the greatest applications of innovation in health care has the promise to unleash the compassion that restores our humanity.

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Offering business services at specially brokered rates to AHA member hospitals – that’s what we do. We bring you projectand/or department-specific consultations that help you connect with companies ALREADY VETTED, ALREADY PROVEN, HOSPITAL-SPECIFIC, and providing special rates for member hospitals.

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Tina Creel and Liz Carder are dedicated to our member hospitals, connecting them with the specific help they need to meet today’s health care business challenges. Whether it’s in the area of Translation Services, Data Analytics, Insurance, Supply Chain Solutions, Staff Education and Certification, or Financial Services, Tina and Liz will help your hospital tap into vetted and proven resources and services as your hospital seeks to improve upon its success.

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AHA SERVICES PRESENTS...

Offers Free COVID-19 Course in Appreciation of Care Teams careLearning wants to show its appreciation to the entire health care community by providing a FREE online COVID-19 course that can be used on your current Learning Management System (LMS) platform.

Designed to help educate your employees during the pandemic, this course was written in accordance with CDC guidelines and reflects the most up-to-date information. It is currently available in a PowerPoint version so that you may edit it for your organization’s needs, and it’s in an LMS friendly format, ready for you to install.

The course is available in two different ways. Choose which works best for your organization: The course is accessible as a part of the Health & Safety Compliance Series. If your hospital already registered employees for this course, they will automatically get updates. If you are not yet using this course for your organization but wish to – please contact careLearning at 866-617-3904, or support@careLearning.com. Our technical support team will assist you.

Keep in mind, careLearning clients subscribing to the Health & Safety Compliance Series also have free access to all of that series’s courses, which include education on Standard and Transmission-Based Precautions and Hand Hygiene, as well as access to the CE Package which includes respiratory care education.

If your team has developed a private course, the course "COVID-19: Coronavirus Disease 2019" is regularly updated in our Course Center in the Private Course Library.

You may find other course titles in the Private Course Library that can assist you during this pandemic as well.

careLearning provides customers with quality, reliable and useful educational and training tools. Our learning management system allows facilities to offer online training from subject matter experts, including those within their own organizations. We offer the ability to track all the education your organization needs in one program.

If you would like more information about careLearning, please contact Liz Carder, LCarder@arkhospitals.org, for assistance.

Our thoughts are with all health care workers and those affected by this crisis. From the bottom of our hearts, we thank you.

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ARKANSAS HOSPITALS | SPRING 2021 45

Improving Health Outcomes: Arkansas Hospitals and The CMS Hospital Quality Improvement Contract

TMF Health Quality Institute Texas Hospital Association Foundation (THAF)

Safe & Reliable Healthcare, LLP

Hospital Partners Arkansas Foundations for Medical Care (AFMC)

Carrot Health

Arkansas Hospital Association (AHA)

By Mandy Palmer Figure 1. TMF HQI Initiative's Technical Expert Panel

I

mproving hospital quality is a multi-organizational effort in the U.S., with new goal-sets and strategies announced every four years. The latest CMS Hospital Quality Improvement (HQI) initiative builds upon lessons learned and achievements made during previous CMS improvement programs. Carried out by Hospital Improvement Innovation Networks and Hospital Engagement Networks over the past decade and more, earlier programs engaged many Arkansas hospitals, and measurable improvement was the result.

With a keen focus on improving patient safety, quality, and outcomes in rural, critical access, and vulnerable populations, the new four-year strategy was launched last fall.

In September 2020, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services named nine organizations, including TMF Health Quality Institute, as Hospital Quality Improvement Contractors (HQICs). Under the new contract, the Arkansas Foundation for Medical Care (AFMC), a subcontractor with TMF since 2014, will continue its work in Arkansas on the CMS Quality Innovation Network-Quality Improvement Organization program.

TMF and AFMC have long provided quality improvement and technical assistance support to hospitals, nursing homes, physicians, and other health care entities. Hospitals can rely on our combined experience and resources to help solve unique health care challenges.

46 SPRING 2021 | ARKANSAS HOSPITALS

AFMC and the Arkansas Hospital Association (AHA) have supported and partnered on many quality improvement projects and efforts over the years. The two organizations hold a vision to serve and support hospitals to create a “one-stop-shop” and “no wrong door policy” to better align and synergize projects, eliminating extra burden, program duplication, and improving health care in Arkansas. Under the new contract, AFMC, as a subcontractor to TMF, and AHA will continue this partnership and will provide direct support in Arkansas for the new HQIC program. (See Figure 1.)

HOSPITAL PARTICIPATION

In alignment with the CMS Rural Health Strategy, TMF focuses on engaging 60 Arkansas rural hospitals, critical access hospitals, and hospitals that serve vulnerable populations and/or have a star rating of two or below. The three goals of the initiative set by CMS include increasing patient safety and quality of care transitions, as well as improving behavioral health outcomes by decreasing opioid misuse.

To meet these goals, each hospital will receive: • Customized technical assistance and actionable data to include social determinants of health data, analytics support, and a deep understanding of rural communities and vulnerable populations.

• Access to the national improvement organization Safe & Reliable Healthcare, a leader in high-reliability transformation. Guidance on the principles of high-reliability organizations is provided, including expertise and proven tools and resources to ensure that our work with small, rural hospitals is transformative, effective, and sustainable. (See Figure 2.)

• Membership in a community of practice focused on learning best practices and accessing evidence-based resources and tools.

• Collaboration opportunities with stakeholders who are committed to quality improvement. This includes other hospitals, post-acute care providers, state hospital associations, trade associations, and community-based organizations.

• Support from an organization with experience in collaborating with and assisting providers during the COVID-19 pandemic.

If you are interested in checking your hospital’s eligibility or to participate in the HQIC program, contact Mandy Palmer, 501-5537712, or Pamela Brown, 501-730-5310. For more information on the HQIC program, please visit tmfnetworks.org/Networks/HospitalQuality-Improvement-Initiative.

Figure 2. TMF’s approach to high-reliability assessment is anchored in Safe and Reliable Healthcare’s framework for safe, reliable, and effective care. Reprinted with permission from Safe & Reliable Healthcare.

Mandy Palmer, RN, CPHQ, CPPS, serves as Manager, Outreach Services Quality, for the Arkansas Foundation for Medical Care.

ARKANSAS’S PARTICIPATING HOSPITALS HOSPITALS ENROLLED* IN THE NEW HQIC INCLUDE:

• Arkansas Methodist Medical Center • Ashley County Medical Center • Baptist Health Medical Center-Heber Springs • Baptist Health Medical Center-Arkadelphia • Baptist Health Medical Center-Hot Springs County • Baptist Health Medical Center-Fort Smith • Baptist Health Medical Center-Little Rock • Baptist Health Medical Center-Stuttgart • Baxter Regional Medical Center • Bradley County Medical Center • Chambers Memorial Hospital • CHI St. Vincent Infirmary • CHI St. Vincent Morrilton • Chicot Memorial Medical Center • CrossRidge Community Hospital • Dardanelle Regional Medical Center • Delta Memorial Hospital • DeWitt Hospital • Drew Memorial Hospital • Five Rivers Medical Center • Forrest City Medical Center • Fulton County Hospital • Great River Medical Center • Izard County Medical Center • Jefferson Regional Medical Center • Johnson Regional Medical Center • Lawrence Memorial Hospital • Little River Memorial Hospital • McGehee Hospital • Mena Regional Health System • Mercy Hospital Booneville • Mercy Hospital Ozark • Mercy Hospital Paris • Mercy Hospital Waldron • North Arkansas Regional Medical Center • NEA Baptist Memorial Hospital • Northwest Health Physicians Specialty Hospital • Northwest Medical Center Springdale • Ouachita County Medical Center • Ozark Community Hospital of Gravette • Piggott Community Hospital • Siloam Springs Regional Hospital • South Mississippi County Regional Medical Center • St. Bernards Medical Center • Stone County Medical Center • UAMS Medical Center • Unity Health-Harris Medical Center • Unity Health-White County Medical Center • Washington Regional Medical Center • White River Medical Center *Hospitals enrolled as of March 11, 2021.

ARKANSAS HOSPITALS | SPRING 2021 47

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48 SPRING 2021 | ARKANSAS HOSPITALS

Vaccinate the Natural State is an initiative to encourage all Arkansans to get their COVID-19 vaccination when it's their time. We’re working in collaboration with multiple business, healthcare and community organizations statewide — including the Arkansas Hospital Association — to educate and engage Arkansans in doing our part to help end the pandemic.

Let's work together to...

Protect caregivers.

Protect families.

Protect communities.

Whether you are providing vaccinations, getting your workforce vaccinated, or encouraging your family and friends, everyone has a role in helping end the pandemic.

Find out more at www.vaccinatethenaturalstate.com

In partnership with:

In collaboration with: ¡ Arkansas College of Osteopathic Medicine/ Fort Smith

¡ Arkansas Medical Dental Pharmacy Association

¡ Arkansas Faith Network

¡ Association of Federally Qualified Health Centers

¡ Arkansas Hospital Association

¡ Community Health Centers of Arkansas

¡ Arkansas Immunization Action Coalition (Immunize Arkansas)

¡ NYIT College of Osteopathic Medicine/Jonesboro

¡ Arkansas Pharmacists Association

10111 3/21

ARKANSAS HOSPITALS | SPRING 2021 49

CONSTRUCTION

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INDUSTRIAL

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E XC AVAT I O N

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E N V I R O N M E N TA L

WE BUILD PLACES OF HEALING

Having completed many projects for the Conway Regional Health System (CRHS) before, we were happy to take on constructing a new 42,500-square-foot, three-story medical office building. This addition to the Conway Regional Health campus will allow CRHS and other medical tenants to expand to meet their patients’ needs.

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S P E C I A LT Y