Catholic Health World - August 15, 2019 by Catholic Health Association

Bipartisan palliative care bill 2 Sr. Lillian Murphy, RSM 7 Could dolls prevent falls? 8 PERIODICAL RATE PUBLICATION

AUGUST 15, 2019 VOLUME 35, NUMBER 14

CHI Franciscan opens futuristic ‘Mission Control’

Staff at work in the CHI Franciscan Mission Control Center in Gig Harbor, Wash. By JULIE MINDA

Between April 2010 and July 2018, the population of Tacoma grew more than 9 percent, to upwards of 216,000, accord-

ing to data from the U.S. Census Bureau. Growth has been similarly swift throughout the Seattle-Tacoma-Bellevue area of northwest Washington. For eight hospitals that are part of CHI

Franciscan of Tacoma, the population spike has meant increasing numbers of patients seeking care, and COMMONSPIRIT a resulting strain HEALTH on bed capacity. And, yet, it is difficult to secure certificate of need approvals to expand bed counts, says Ian Worden, CHI Franciscan chief operating officer. Two years ago, Worden learned of a collection of high-tech tools from GE Healthcare that promised to improve the efficiency of the health system’s operations. The improved efficiency, the vendor said, would lead to better management of patient beds, which would free up capacity and allow for more patient admissions — without having to add beds. Earlier this month, CHI Franciscan became the fifth health system in the world to employ the GE Healthcare technology platform. Worden says the new system will improve CHI Franciscan’s ability to “ensure we get care to patients at the appropriate time and have the healing environment needed. Continued on 3

Civica Rx announces deals to manufacture 16 essential drugs Civica Rx has announced that it will make 16 essential injectable medications that often are in short supply available to hundreds of U.S. hospitals, with deliveries expected to begin by the end of this year. Five Catholic health ministry systems are among the more than 30 health systems that are members of the Lehi, Utah-based nonprofit generic drug company. Its member systems represent more than 900 U.S. hospitals. The 16 drugs will be the first in the Civica Rx product line. Civica Rx also has announced it will partner with the health care performance improvement company Vizient, to better anticipate supply chain shortages of specific essential drugs. Civica Rx was launched in September 2018 to disrupt the generic drug market by alleviating chronic shortages of vital drugs and to set competitive conditions that support sustainable, fair pricing for Continued on 6

Photo courtesy SSM Health

By KEN LEISER

Beth Kilzer, clinical pharmacist at SSM Health St. Mary’s Hospital – St. Louis, preps and checks for sterile compounding of magnesium to be administered intravenously to patients. SSM Health is a member of a generic drug company that is producing pharmaceuticals to relieve scarcity and price barriers in the drug supply chain.

Chang

Heintzkill

Screening tool helps Ascension identify outpatients with pressing spiritual care needs By JULIE MINDA

St. Louis-based Ascension has made it a strategic priority to ensure that patients receiving care outside ASCENSION of the hospital walls get access to spiritual care. To identify outpatients who may benefit from — and be receptive to — a spiritual care consult, the system is beginning to screen for unmet spiritual care needs in its broader patient intake assessments. Ascension began this initiative last summer, by asking patients in its remote care monitoring program three screening questions to gauge their level of spiritual distress and referring those with pressing needs to remote chaplaincy services. Ascension currently is piloting the screening tool in some inpatient and ambulatory care settings as well. The Rev. Cathy Chang, Ascension’s director of on demand spiritual care and mission integration, and Mary M. Heintzkill, Ascension director of spiritual care and mission integration, talked with Catholic Health World about the spiritual assessment tool. How did you land on three questions that would be a valid barometer of spiritual health? Heintzkill: We knew patients would be overwhelmed if we asked too many questions. We ask questions that get at a patient’s level of concern when it comes to loss of meaning and/or joy, spiritual or religious issues and end-of-life issues. Depending on their response, there is a referral made to a chaplain. We are finding that about Continued on 4

Providence St. Joseph wellness program aims to reengage physicians, staff System plans to expand ‘Own It’ throughout seven-state network

When Dr. Chad Wadell graduated from medical school about 15 years ago, he says, he felt ready to change PROVIDENCE the world, and he was ST. JOSEPH impassioned about the HEALTH prospect of providing healing medical care to his patients. And while his commitment to providing high-quality care has not waned, at times

St. Joseph Heritage Healthcare

By JULIE MINDA

St. Joseph Heritage Healthcare in Southern California’s “Own It Gallery Walk” in Anaheim, Calif., shows creative works by caregivers who participated in Own It, the cultural transformation program from Providence St. Joseph Health. St. Joseph Heritage is a medical group associated with the system.

his passion and enthusiasm for being a physician has. He has experienced bouts of burnout — times when he felt disconnected from his patients. For Wadell, who is a primary care physician with Mission Heritage Medical Group in Mission Viejo, Calif., the necessary but intrusive role of technology has been a culprit. “With the electronic medical record, we’re spending lots of time with the computer — in fact we often spend most of our time with the computer, and it’s like a hamster wheel,” because of the seemingly never-ending list of tasks connected with using the IT system. This can intrude upon the physician-patient relationship. Continued on 5

CATHOLIC HEALTH WORLD August 15, 2019

Ministry continues push for palliative care legislation to increase training, research, awareness By INDU SPUGNARDI

that we have the workforce to meet the growing need for quality end-of-life care. The Palliative Care and Hospice Educa- I commend my colleagues for their ongotion and Training Act, legislation that will ing commitment to improving support and help expand access to palliative care, has medical care for patients at the end of life.” On July 7, Sens. Tammy Baldwin, D-Wis., been reintroduced in the 116th Congress and is quickly gaining widespread biparti- and Shelley Moore Capito, R-W.Va., reintrosan support. The bill’s provisions will estab- duced the Senate version of the bill, S. 2080, lish training and education opportunities to in the Senate along with Sens. Angus King increase the palliative care workforce; fund Jr., I-Maine; Cindy Hyde-Smith, R-Miss.; Kyrsten Sinema, D-Ariz.; research to improve “This bipartisan bill Kevin Cramer, R-N.D.; clinical practice; and Jeanne Shaheen, D-N.H.; increase awareness of will improve education, and John Hoeven, Rthe benefits of palliative N.D. care among patients, training, and research Baldwin said in a families and providers. into palliative and press statement, “I was In the last Congress, raised by my maternal Catholic health care hospice care.” grandparents and later and other palliative care advocates made great — Rep. Frank Pallone Jr., D-N.J. served as my grandmother’s primary carestrides in garnering support for the Palliative Care and Hospice giver as she grew older, so this issue is Education and Training Act. The bill passed personal to me, and I want to make a difthe U.S. House of Representatives by unani- ference for families experiencing serious mous consent and had 56 co-sponsors in health concerns. I’m proud to work across the Senate. Unfortunately, the Senate bill party lines and reintroduce the bipartisan was still going through the committee pro- Palliative Care and Hospice Education and Training Act with my colleague Sen. Capcess when the 115th Congress ended. On Jan. 17, the bill’s original co- ito. We must do more to grow our health sponsors, Reps. Eliot Engel, D-N.Y., and care workforce to safeguard and improve Tom Reed, R-N.Y., reintroduced H.R. 647 in the quality of care for the growing number the House along with Reps. Yvette Clarke, of patients with serious or life-threatening D-N.Y., Buddy Carter, R-Ga., and leaders of illnesses.” The Patient Quality of Life Coalition, a the House Committee on Energy and Commerce Frank Pallone Jr., D-N.J., and Greg group of over 40 organizations representing patients, survivors, family caregivers, health Walden, R-Ore. “This bipartisan bill will improve educa- care organizations, physicians, nurses, tion, training, and research into palliative social workers, chaplains and researchand hospice care,” energy and commerce ers, is coordinating efforts to secure cochairman Pallone said in a press statement. sponsors and help move the bills through “This important legislation will help ensure the legislative process. CHA, Trinity Health and the Supportive Care Coalition are members of the group and are working to bring the Catholic health ministry’s support behind the legislation. When Catholic Health World went to press, the House bill The Aug. 1 edition of Catholic Health had 258 co-sponsors and the Senate bill had World contained a story about a team from 23 co-sponsors. On July 19, the United States Conference Providence St. Joseph Health who volunteered at an immigrant respite center in of Catholic Bishops joined with CHA in a McAllen, Texas. The story misstated that a volunteer team member thwarted an apparent abduction. The incident was not an attempted abduction. In addition, that volunteer team member was misidentified as a refugee. She was born in the U.S.; many of her family members are immigrants.

Correction

Catholic Health World (ISSN 8756-4068) is published semimonthly, except monthly in January and July, and copyrighted © by the Catholic Health Association of the United States. POSTMASTER: Address all subscription orders, inquiries, address changes, etc., to Kim Hewitt, 4455 Woodson Road, St. Louis, MO 63134-3797; phone: 314-253-3421; email: khewitt@ chausa.org. Periodicals postage rate is paid at St. Louis and additional mailing offices. Annual subscription rates: CHA members $45, others $55 and foreign $55. Opinions, quotes and views appearing in Catholic Health World do not necessarily reflect those of CHA and do not represent an endorsement by CHA. Acceptance of advertising for publication does not constitute approval or endorsement by the publication or CHA. All advertising is subject to review before acceptance. Vice President Communications and Marketing Brian P. Reardon

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letter to senators in support of the Senate lic health care providers have formed the bill. The letter describes the alignment of Whole Person Care Initiative, which helps palliative care with Catholic tradition and dioceses and parishes provide people with values: “Catholics believe that human life is information on advance directives, palliaa gift from God that no one may dispose of tive care and hospice options. The initiative at will. All persons, regardless of their medi- also includes various parish ministries that cal condition, possess inherent dignity and can support people at the end stages of their are worthy of respect, love and support. As lives. CHA is offering workshops to dioPope Francis stated in his 2015 address to the Pontifical Academy for Life assembly ceses across the country to help clergy be a on assistance to the elderly and palliative resource to parishioners facing the end of care, ‘palliative care is an expression of the life and has developed booklets that explain truly human attitude of taking care of one advance care planning, palliative care and another, especially of those who suffer. It is a the teachings of the Catholic Church on testimony that the human person is always caring for people at the end of life. The Supportive Care precious, even if marked by illness and old age.’” Coalition, a national Cath“We need more The Catholic Church olic organization working trained clinicians recognizes that good palto advance excellence in liative care, with its focus and the knowledge palliative care, offers its on improving the qualmembers educational, ity of life of the patient, base to support the ethical and theological resources relative to palis critically important in delivery of highliative and end-of-life care, a culture it views as not adequately supporting quality palliative care including expert resources on incorporating spirituthe seriously ill and dying. In 2017, the Pontifical so we can ensure that ality into palliative care practice. Academy for Life began The efforts of the the PALLIFE Project, all who need palliative ministry and the church which sets up an internacare can receive it.” around palliative care tional study group to sup— Lisa Smith depend on building a port the academy in the strong palliative care promotion of palliative care throughout the world. The PALLIFE infrastructure, which is what the Palliative website notes, “The Pontifical Academy Care and Hospice Education and Training for Life views with deep admiration and Act will help do, noted Lisa Smith, CHA gratitude the palliative care movement vice president of advocacy and public polthat has grown up in the medical profes- icy. “We need more trained clinicians and sion today as an answer to the needs of a the knowledge base to support the delivery class of humanity — the ‘dying’ — that is of high-quality palliative care so we can clearly fragile and that, without the vigor- ensure that all who need palliative care can ous spirit of solidarity that inspires the pal- receive it,” Smith said. To learn more about how organizaliative care movement, would all too easily remain subject to the risk of marginaliza- tions can support the legislation and about efforts to promote palliative care, visit tion and exclusion.” In the U.S., the church and the Catholic CHA’s advocacy and palliative care pages health care ministry are undertaking sev- at chausa.org/advocacy/issues and chausa. eral initiatives to promote palliative care org/palliative/palliative-care. including: In California, bishops and Catho- ispugnardi@chausa.org

Upcoming Events from The Catholic Health Association Essentials for Leading Mission in Catholic Health Care

Sponsor Formation Program for Catholic Health Care

A CHA webinar co-sponsored by Vizient Sept. 4 | 2 – 3 p.m. ET

Diversity and Disparities Networking Call

Environmental Networking Conference Call

The Urgent Need to Heal Our Home: A CHA Feast of St. Francis Webinar

Community Benefit 101: The Nuts and Bolts of Planning and Reporting Community Benefit

Staffing Metrics for Pastoral Care in Acute Care Settings Webinar Aug. 27 | 2 – 3:30 p.m. ET

Tax Exemption Issues Webinar

Sept. 5 | 2 p.m. ET

Webinar: Transforming Spiritual Care Research into Policy and Practice

In-Person Meeting: Sept. 9 – 11 Plus Five Online Sessions

Sept. 26 | 1 – 2 p.m. ET

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Sept. 18 | 1 p.m. ET

Session One: Oct. 10 – 12 Chicago (Invitation only)

Chase Park Plaza Royal Sonesta Hotel St. Louis Oct. 15 – 16

Deans of Catholic Colleges of Nursing Networking Call Oct. 22 | 3 – 4 p.m. ET

A Passionate Voice for Compassionate Care® chausa.org/calendar

August 15, 2019 CATHOLIC HEALTH WORLD

From page 1

“At the time when people are most vulnerable, we want to make them feel they’re in great hands. We do this by showing we know how to coordinate care that is in their best interest. This comes about when Worden we have tight operational control,” Worden says.

Centralized hub New hardware at a hub in Gig Harbor, Wash., and at three satellite locations — much of the technology is from GE Healthcare — captures a wealth of data from all patient records, as well as information related to hospital operations, staffing and finances. All this input is processed through GE Healthcare software that uses artificial intelligence applications including machine learning, predictive analysis and high-velocity data fusion to make the data actionable, according to Worden. (See sidebar.) A growing team of 50-plus physicians, nurses, analysts and other experts staffs CHI Franciscan’s new Mission Control Center, which is in a medical office building in Gig Harbor, Wash., about 12 miles northwest of Tacoma. CHI Franciscan has satellite centers at its hospitals in Washington’s Federal Way, Tacoma and Silverdale. Mission Control is staffed by about 20 people during the day and eight at night. They monitor a wall of 18 big-screen monitors displaying 12 “analytical tiles” of information that can be viewed from any vantage point in the room. GE Healthcare and CHI Franciscan worked together to customize and configure what data is pulled, processed and displayed on each tile. That main room is set up as a 24-station “bull pen.” Staff can pull up more granular information from the system on desktop computers, tablets or smartphones. The tiles tell a story of what is happening at all CHI Franciscan hospitals simultaneously. This includes — or will include within the next several weeks as the rampup continues — data on how many beds are occupied, room preparation by environmental services staff, which beds are available and where, patient care activity, staffing, procedure scheduling, and other topline data. Mary Ragsdale, a nurse executive who chairs the CHI Franciscan Mission Control board and the system’s virtual hospital, says having centralized data already is “forcing us to Ragsdale change our culture — we’re no longer viewing ourselves as individual facilities, but as one large system where we’re all reliant on one another.” Logjams and bottlenecks The combination of data aggregation technology and thoughtful analysis from Mission Control staff makes data actionable in real time, say Worden and Ragsdale. In the past, clinicians and back office staff had a lot of data at their fingertips, but they felt bombarded with information without the tools to process it efficiently. The result, says Worden, was logjams in patients’ movement around the hospitals to access various needed services. In time, Worden expects the system will cut wait times and he hopes in the near future to be able to provide patients with a type of itinerary, so they will know exactly what to expect and when during their hospital stay. Already the Mission Control staff and their colleagues at the satellite centers use information on the tiles to identify issues before they arise. This approach includes — or shortly will

include — using “big picture” the situation and then finds ways analytics to track patients’ to help, primarily by “empowercare in order to ensure baring and serving the hospitals and riers are addressed so that care teams. patients do not have to wait “Mission Control staff help as long for a bed, a test or a to expedite care,” Worden says. procedure. The data analytics “That’s central to their work. This can be used to determine if a is needed because patient care particular patient or patients delivery is so complex and crosswould be better served at a functional. Mission Control staff different site — perhaps at have the data and time to spot and a CHI Franciscan hospital close gaps, sometimes even precloser to their home, or at dict gaps.” one with a different level of The system can flag patients physician expertise such as a whose length of stay is long for tertiary-level facility. The their condition. Analysts can then system can speed up the work with clinicians to determine discharge process by flagwhy that is the case and whether ging bottlenecks for staff changes in the care plan are even before patients become Dr. Jessica Kennedy-Schlicher is the medical director of the CHI Franciscan needed. aware of a delay. “In the long run, we’ll be able Mission Control Center. to take care of more patients The platform also uses predictive analysis to determine appropri- way before” — presented in a transparent, as we get more efficiency,” says Worden. “We’ll be streamlining processes so that ate staffing levels a day or two in advance, visual and easy-to-act-on way. we can deliver more care at the bedside to inform the managers tasked with setting but at a lesser cost.” work schedules. Closing gaps CHI Franciscan will be ensuring care Ragsdale, who is vice president, chief Worden and Ragsdale described how the operating officer and chief nursing officer of system works from a practical standpoint: quality is not only maintained with the St. Anthony Hospital in Gig Harbor, says in For each tile or alert that appears on a tile, new system but also improved, says Worsome cases CHI Franciscan is using data it there is an “owner” at Mission Control and den. As new functionality comes on line always has had on hand and in some cases a predefined protocol that had been devel- in the coming weeks, it will be able to flag it is using newly mined data. But the key, oped with staff. Worden says when an alert when there is a digression from an evishe says, is that “we haven’t seen data in this appears on a tile, the owner first researches dence-based protocol for an individual patient.

Artificial intelligence functions make raw data usable

ccording to information from CHI Franciscan, the Mission Control Center relies primarily on these artificial intelligence applications:

Machine learning: Algorithms enable the system to “learn” to detect patterns through regular review of performance data. The learning enables recommendations for adjustment. Predictive analysis: A type of machine learning that anticipates elements like patient census and problems like care bottlenecks. High-velocity data fusion: The software processes massive amounts of information very quickly.

Possibilities Worden says CHI Franciscan is focusing first on the patient flow and capacity improvements and will turn to the clinical oversight in the coming weeks. While the Mission Control system currently is focused on inpatient care data, it has data represented on the tiles that is related to prehospital and post-acute care areas as well. Worden says, “I’m excited to see how our command center might evolve to add value to the health system across patient care spaces.”

CHI Franciscan Mission Control

Harrison Medical Center St Francis Hospital St Joseph Medical Center

Mission Control Gig Harbor

Tiles provide real-time decision support

GE Wall of Analytics Hosted in Microsoft Azure Cloud

Orders System

OR System

Hospital Systems Data pulled from existing source systems

Radiology System

ED System

Beds System

Lab System

Pharmacy System

Staffing System Courtesy of CHI Franciscan

‘Mission Control’

CATHOLIC HEALTH WORLD August 15, 2019

Spiritual care screening

only afford limited minutes per month. Connecting patients with resources often means helping the patient figure out what resources they have locally, in their families, and internally, as well as having the patient identify what is important to them.

From page 1

20 percent of the patients in our remote care monitoring program (for patients with serious chronic illness) are experiencing spiritual distress and that chaplain intervention is appropriate in these cases.

What feedback have you received about this spiritual assessment? Heintzkill: We’re hearing good things from the teams using the assessment. When a team realizes a patient is in spiritual distress, it’s so much better to have a chaplain respond — the chaplain has the expertise.

How was the tool developed? Chang: This screening tool was based off the study, “Determining the best methods to screen for religious/spiritual distress,” by Stephen King and other authors. It is from the Supportive Care in Cancer journal, from 2016. How is the tool administered? Heintzkill: The three questions are part of a larger assessment that a nurse completes with each patient when the patient is brought into the remote care monitoring program. This larger assessment covers the patient’s physical, emotional and spiritual health and other topics. Depending on the score, referrals are made. Our remote care monitoring involves a multidisciplinary team — that could include a doctor, nurse, social worker and others. That team is monitoring patients with cardiac and chronic disease to help them get to the level of optimal functioning. The chaplain is really integral to our multidisciplinary teams. What is the interplay between spiritual and behavioral health, when it comes to the assessments? Chang: Our tool is designed to screen for spiritual distress. The behavioral health teams have their own screener to catch behavioral health needs, and those trigger a social worker, or a behavioral health expert being added to the team. As always, we do refer back and forth, so if a social worker sees something that is a spiritual need, they will refer to a chaplain, or vice versa if the chaplain sees a possible behavioral health need. What happens when a patient is referred to a chaplain? Heintzkill: An Ascension chaplain does a more thorough assessment of what is causing the distress and identifies resources to help the patient get to a place of more meaning. Currently the chaplains who respond (to the patients in the remote monitoring program) do so by phone or over the web. Our remote care team chaplains are working out of Florida, Indiana and Texas. What are some of the ways chaplains help patients get to a place of more meaning? Chang: The chaplains help the patient find meaning in light of their current circumstances. For instance, we’ve heard several stories about patients who are isolated, or even self-isolating, because they don’t feel they can their share their circumstances with their loved ones. But after working with the chaplain, they’ve often found ways to open up to their loved ones, which has given the patients a lot of peace, because they have more support. The chaplain can help the patient find their own internal spiritual strengths or reconnect with God or the spiritual. How much contact does a chaplain have with remote monitoring patients who have expressed spiritual needs? Chang: Typically, the chaplain is spending about an hour per patient per week, but that includes time trying to reach the patient, which is often challenging even when meetings are scheduled for a virtual or telephone visit. Also, not every patient needs to talk every week. Depending on the patient and the patient’s circumstances — medical, spiritual and emotional — they may need to talk every few weeks rather than every week. Services from a chaplain end when either

What advice would you offer others considering using a similar approach? Heintzkill: There is a lot of integration needed. For instance, you need to work with IT to embed the tool’s questions into the larger assessment, you need nurses administering the tool who will understand the importance of the questions. And you need other team members like social workers and physicians who are on board. So my best advice is to not work in a silo.

Alina Masavage, a nurse case manager with Ascension St. Vincent Indiana, conducts an intake assessment with a patient. Spiritual care questions on the assessment are intended to flag patients who would benefit from a referral to a chaplain.

the patient is discharged from the remote patient monitoring service — typically 90 to 120 days — or earlier if the patient’s spiritual needs have been addressed. Heintzkill: We’re in the process of developing more and more connections with community resources that a patient can tap for ongoing spiritual support.

Questions to assess spiritual health needs

hen a patient enrolls in Ascension’s remote monitoring program, a nurse conducts an assessment with the patient in person, by phone or via a web-based survey instrument. As part of that assessment, the nurse asks questions related to the patient’s spiritual health. The nurse begins by saying: “At Ascension Health … we’re committed to caring for the whole person: body, mind, and spirit. Because of this commitment to holistic care, I’d like to ask you a few questions to determine any level of concern you might have in a few areas.” The nurse then walks the patient through the assessment, which includes three questions used to assess spiritual health. Patients are asked to assess the following measures: Level of concern related to loss of meaning and/or joy in life Not at all Somewhat Quite a bit A great deal

Level of concern related to spiritual or religious issues Not at all Somewhat Quite a bit A great deal Level of concern related to end-oflife issues Not at all Somewhat Quite a bit A great deal If the patient answers “somewhat” to two or more questions, or “quite a bit” or “a great deal” to any questions, then a referral for spiritual care is made.

What are some of the challenges of connecting patients to such resources? Chang: The majority of patients who are referred to us are in very remote rural areas — or the patient is often homebound for physical and/or financial reasons. Even telephone resources for support groups can be a financial burden, as many can

What are the main benefits of this approach? Heintzkill: It helps zero in with the patient on what is important to them. We’re developing new competencies for chaplains as we enter new areas of service like this one. And it’s been great fun and an adventure to move into this next era of spiritual care. We’re reimagining how we can empower people to live with cardiac disease and chronic illness. jminda@chausa.org

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August 15, 2019 CATHOLIC HEALTH WORLD

From page 1

Physician burnout The 2018 “Survey of America’s Physicians Practice Patterns and Perspectives” by the Merritt Hawkins physician recruiting firm found that 78 percent of physicians completing the poll had experienced burnout. According to information from Providence, in addition to the suffering of burned-out employees, clinician burnout can lead to lower patient satisfaction scores and a higher rate of medical errors. And since burnout also is a concern among other clinicians and for staff outside of the clinical realm, Providence is expanding Own It to these other groups, and tailoring it to their circumstances, says Kevin Manemann, executive vice president and chief executive for Providence’s physician enterprise. St. Joseph Heritage Healthcare

But about five years ago, Wadell took part in a cultural transformation program called “Own It,” from Renton, Wash.-based Providence St. Joseph Health, that he says is helping him feel reinvigorated about his chosen profession. Own It involves inperson learning sessions that help participants reconnect with the healing purpose of their profession, as well as follow-up programming to keep them tapped into what they learned. The health system is rolling Own It out to all staff and providers in all of its owned or affiliated medical groups and it plans to open up participation to all staff in the Providence St. Joseph system. That includes clinical and nonclinical staff at Providence St. Joseph hospitals. Own It starts with a four-hour inperson learning session intended to help participants tap into the reasons they wanted to practice medicine and to connect in a meaningful way with the people they work with. The follow-up programming keeps participants practicing the

interpersonal skills and centering skills they’ve learned. Wadell is part of the team that is spreading Own It throughout Providence St. Joseph’s seven states. He says, “I will tell you until the cows come home that this is one of the best programs we’ve had. It improves how we relate to (other physicians), our colleagues Wadell and our patients. When we get back to our purpose, it makes each day go better.”

A nurse care manager with St. Joseph Heritage Healthcare based in Anaheim, Calif., submitted this artwork called “Own the Patient Experience,” for the Own It Gallery Walk.

Computer v. human Manemann explains that burnout among physicians and other clinicians is connected in part to the fact that the

ark Kuczewski, professor of medical ethics at the Loyola

University Chicago Stritch School of Medicine, and Fr. Corey Brost, director of Viator House of Hospitality, discuss the many challenges facing undocumented youth and share their insights on what Catholic health care can do to support these vulnerable youth on the latest episode of Catholic Health USA. We invite you to subscribe to the podcast on your device store or download/listen to it using these players: chausa.org/newsroom/podcast

Caregivers at one of St. Joseph Heritage Healthcare’s Southern California medical groups meet for an Own It session in Fullerton. St. Joseph Heritage is a physician group associated with Providence St. Joseph Health.

U.S. health care system has been going through so much change, so quickly — and that change is accelerating over time. Many physicians have moved from private practice to physician groups, and those groups have been Manemann acquired by larger organizations. The culture and rules of a large health system are often much different than what the clinicians are used to. Manemann says many clinicians went into medicine to interact with patients but end up feeling like they’re spending most of their time clicking around in electronic medical records in order to meet health care regulations, including the Centers for Medicaid & Medicare Services requirements for “meaningful use” of electronic health record technology. Wadell says a common and longstanding complaint among doctors is that they are not having the intuitive conversations about the patients’ needs that they want to have, because they run out of time during office visits filling mandatory fields on the electronic medical record. Manemann says Own It sets the stage and gives permission for clinicians and other staff to address the problems that are undermining their satisfaction with their work. It establishes a culture and a context for more positive interactions with peers, and for clinicians and staff to seek more open and more authentic dialogue with one another.

Culture change Own It began as an initiative to unite the cultures of medical groups merging together under the St. Joseph Heritage Healthcare organization in Southern California. That organization houses physicians practicing at Providence facilities in that region. (California law prohibits direct employment of physicians by hospitals.) Mission leaders, administrators and executives in charge of operations, nursing leaders, and physician leaders employed by or affiliated with Providence facilitate the Own It sessions. Approximately 30 to 40 physicians and other physician office staff taking part in each session are grouped at tables based on their profession. Manemann says doctors seem more comfortable expressing vulnerability with their peers, and the same holds true for members of other professions. The content covers Providence’s mission, vision and values. It explains what sacred encounters are and how they can be created. Through presentations, discussion and introspection, Manemann says, participants explore the importance of culture,

St. Joseph Heritage Healthcare

Reengaging physicians

how their choices either improve or denigrate the atmosphere in the workplace and the whys and hows of taking a mindful perspective on the interactions they have daily in their work. Participants declare their commitment to greet, respect, engage with and assist others, and to help them to their next step in healing. Participants learn the importance of making meaningful connections even in brief encounters through eye contact, active listening, clear communication, and asking what else one can do to support others.

Connection Suzi Bruttig, chief nursing officer of Providence’s California physician enterprise, was one of the main architects of Own It. She says nurturing human connections can add to an individual’s sense of fulfillment at work. Bruttig Own It programming also includes “sustainment” activities that physician enterprise sites can tailor to their physicians and staff. This can include department huddles or brown bag lunches where colleagues talk about how they are implementing Own It concepts in their daily work, departments creating recognition programs for those excelling in using the Own It protocols, and departments providing training to model for colleagues behaviors and interactions that contribute to a healthy culture. More than 1,300 Providence and Providence-affiliated physicians and more than 6,200 Providence and Providenceaffiliated staff have taken part in Own It. Providence has found through surveys that Own It has improved patient and physician satisfaction. Bruttig says one physician told her that Own It helped bring back the joy and meaning of medicine by giving the doctor permission to establish more personal connections with patients. Manemann says participants have told him that the training has challenged them to examine their interactions and habits and to make changes so that they are engaging in a more positive way with colleagues and patients. Wadell says many physicians, himself included, arrive to the training as skeptics and depart as fans. “It gets us back to the personal interaction — and after all, that’s why we got into this profession. When we get frustrated, we know we can get back to our purpose. And, when we have a purpose, we’re less likely to burn out.” jminda@chausa.org

CATHOLIC HEALTH WORLD August 15, 2019

Civica Rx From page 1

drugs that are crucial tools in the hospital pharmacopoeia. Daniel Liljenquist, the chief strategy officer of Salt Lake City-based Intermountain Healthcare, conceived of the idea for a nonprofit drug company that could remedy market shortages of essential drugs and make product available at prices that could potentially discourage Liljenquist excessive price increases by other drugmakers. Liljenquist chairs the Civica Rx board. Carter Dredge, SSM Health’s chief transformation officer, was assistant vice president for health care services at Intermountain when Liljenquist was mapping out the business plan for the generic drug company start-up and he is a member of the Civica Rx board. “We Dredge came up with the derivative value financing structure,” Dredge told an audience at a breakout session at the AHA Leadership Summit in San Diego last month. Civica Rx initially raised $100 million — $70 million from health systems and $30 million from health care philanthropies — all of which became governing members. Newer members since have contributed an additional $60 million in capital. “If you raise money from the people who buy the drug, there is no equity in the company. In the end there is no incentive to increase the price of the drug,” Dredge said. The goal of Civica Rx is not to produce all needed drugs, rather “the goal is to act to some extent as a conscience” for the generic drug industry. “As long as you are making a fair margin, great, keep going. If someone starts to get really greedy in their pricing mechanisms, we are going to come in,” Dredge said of Civica Rx. Liljenquist said of Civica Rx: “Our goal is to stabilize the market — to make sure that essential generic medications are available and affordable to everyone.”

The short list In May, Civica Rx announced it will partner with Xellia Pharmaceuticals of Copenhagen, Denmark, to produce the antibiotics vancomycin and daptomycin for purchase by Civica Rx member health systems’ hospitals. Both drugs are potentially lifesaving. Liljenquist said vancomycin, a broad-spectrum antibiotic used to treat drug-resistant infections in hospital settings, was the No. 1 drug on the Civica Rx priority list. Daptomycin often is held in reserve for the very severe, multidrugresistant infections. In late July, Civica Rx announced it had entered a five-year agreement with Hikma Pharmaceuticals PLC, a multinational generic drug company. Londonbased Hikma will make 14 essential sterile injectable medications including drugs hospitals commonly use in emergency care, in surgery, for pain management and in the treatment of hypertension. Civica Rx will distribute the drugs to its members under its private label. The list of 14 drugs had not been made public as Catholic Health World went to press. Mohammed “Mo” Kharbat, regional vice president of pharmacy services for St. Louisbased SSM Health, said Kharbat vancomycin has been on SSM Health’s “shortage list,” which is used to track drugs that are not available or could become unavailable. Vancomycin is “extremely important clinically,” because it treats potentially deadly infections, he said.

Kharbat is based in Madison, Wis., and represents SSM Health on pharmaceutical matters in the Civica Rx initiative. SSM Health is a founding and governing member of Civica Rx as are Trinity Health and Providence St. Joseph Health. (Another governing member, Catholic Health Initiatives, combined with Dignity Health to create CommonSpirit Health, which now has a seat on the Civica Rx board.) Hospital Sisters Health System is a founding member of Civica Rx.

Public utility model The idea for the structure of Civica Rx — “essentially our own public utility model that nobody would own, and nobody would try to monetize and take public” — came to Liljenquist while he was running on a treadmill in August 2016. “This model is open to everybody,” Liljenquist said. “We want everybody to be with Civica in this model. Nobody owns this company. Every health system no matter how big or how small will get the same per-unit price. There will be total transparency on what it costs Civica to make the drugs.” Lou Fierens is executive vice president of administrative services at Livonia, Mich.-based Trinity Health and a Civica Rx board member. He said that apart from netFierens working inside the industry, there is no real desire by members of Civica Rx to trumpet the company’s

accomplishments. “It is more about the deeds, than the words,” Fierens said. “Since Civica Rx is solving problems that are very deeply and consistently felt throughout the health care industry, we find ourselves having to facilitate, rather than generate, interest in participation,” he said. Kathleen Sanford is executive vice president and chief nursing officer for Chicago-based CommonSpirit Health and a Civica Rx board member. She said the model has stirred interest and a “real excitement” in the health care industry. Sanford “Everywhere I go people ask me about them,” Sanford said.

Long history of drug shortages In June, Civica Rx and Vizient announced that Vizient will help Civica Rx anticipate gaps in drug availability and affordability. Dan Kistner, group senior vice president of pharmacy solutions at Vizient, said the two companies share the same mission. Vizient is a health care performance improvement company Kistner whose stated mission is to “connect health care organizations and providers with the knowledge, solutions and expertise that enable them to accelerate their clinical and operational performance.”

“Drug shortages are not a new thing,” Kistner said. “They have been around really for the last 20 years and it’s been really bad, in particular, in the last decade.” In a recent survey, Vizient found that U.S. hospitals waste $359 million of labor every year trying to manage drug shortages. It amounts to 8.6 million hours of physician, pharmacist and clinician time spent annually responding to drug shortages. Kistner said Vizient maintains a clinical webpage where its members can share protocols and alternatives for use when a vital drug is in short supply. “We try to take the best practices from our members and then we share them with everyone else,” Kistner said. Sanford said, “I can make rounds in any of our hospitals on any given day and in the pharmacy, there is a white board listing which drugs are in shortage that day. There’s always a list.” When drugs are in short supply, the hospital will look for “spot buying” opportunities and will share drugs among facilities, which can take time and energy, Sanford said. In some instances, CommonSpirit will go to a compounding pharmacy vendor as a last resort, which is an expensive source. Drug shortages “put pressure on us as a health system,” Kharbat agreed. Once a health system obtains an alternative product, clinicians will have to know how to dose the drug and administer it safely, so “that also has an impact on our clinicians.”

Anticipated: 100+

CIVICA MANUFACTURES Civica facilities manufacture directly

Anticipated: 40+

CIVICA ANDAs*, CMOs*

Civica gains FDA license, produces via contract mfg

Target: 14 Products FDA APPROVED MANUFACTURERS

FDA APPROVED MANUFACTURERS

Including dormant manufacturers with capable facilities/capacity to make Civica labeled drugs

2019

2-3 YRS

FUTURE

*ANDA- Abbreviated New Drug Application *CMO-Contract Manufacturing Org.

August 15, 2019 CATHOLIC HEALTH WORLD

Sr. Lillian Murphy, RSM, led Mercy Housing for almost three decades By LISA EISENHAUER

Sr. Lillian Murphy, RSM, the former president and chief executive officer of Mercy Housing, died July 25 in San Francisco. She was 78. “Her commitment and impact on affordable housing and to those in need will forever be felt,” Mercy Housing President and Chief Executive Jane Graf said in announcing Sr. Murphy’s death. In 1987, Sr. Murphy became the nonprofit’s second leader and she stayed in that role until she retired in 2014. Under her guidance, Mercy Housing expanded from a regional organization with 250 housing units and 20 staff members to one with almost 24,000 units housing more than 42,000 low-income individuals and families. Mercy Housing employs more than 1,500 people in 21 states, according to a statement from Mercy Housing. Sr. Mary Haddad, RSM, CHA’s president and chief executive officer, got to know Sr. Murphy while serving on the leadership team for the Sisters of Mercy in St. Louis. The regional community provided financial support for Mercy Housing. The pair often crossed paths as Sr. Murphy took leadership roles in health care, serving on the boards of Catholic Health Initiatives and its public juridic person, the

CHA Senior Director, Mission Integration and Innovation This position provides thought leadership in the areas of mission innovation and integration. As an interdisciplinary position, the focus is to identify, develop, and coordinate programs, products, and services for ministry leaders responsible for mission integration. Additionally, this position is responsible for connecting mission executives through committee meetings to facilitate the development and sharing of successful practices in these areas. Travel is required. The Catholic health ministry is the largest group of nonprofit health care providers in the nation comprised of more than 600 hospitals and 1,600 long-term care and other health facilities. To ensure vital sponsorship and a vibrant future for the Catholic health ministry, CHA advocates with Congress, the administration, federal agencies, and influential policy organizations to ensure that the nation’s health systems provide quality and affordable care across the continuum of health care delivery. Minimum qualifications: CHA is seeking candidates with a minimum of five years working in a leadership position in mission integration at a local, regional, or national health care level. This position requires a minimum of a master’s degree in theology or related field (or equivalent work experience). To view a more detailed posting for this position, visit the careers page on chausa.org.

Catholic Health Care Federation. Sr. Haddad served on Mercy Housing’s board at Sr. Murphy’s invitation. “Sr. Lillian’s acute sense of business combined with her Sr. Murphy passion for serving people in need created the driving force behind Mercy Housing,” Sr. Haddad said. “She was impelled by its mission and worked to integrate the founding values throughout the organization. People were inspired by Sr. Lillian’s leadership. She was the face of Mercy Housing.” Sr. Murphy was born in San Francisco. She was the seventh of eight children born to Denis and Katherine Driscoll Murphy. She attended St. Peter’s elementary and high schools in the Mission District, where she came to know the Sisters of Mercy. She entered the community in 1959 and was given the religious name of Sr. Mary Denis, professing perpetual vows in 1967. She earned a bachelor’s degree from Russell College in Burlingame, Calif., in 1965 and a master’s in health services administration from University of California Berkeley in 1977. Her ministries included associate administrator at St. Mary’s Hospital in San Francisco, according to an obituary from Sisters of Mercy. During her tenure at St. Mary’s she assisted in the conversion of the old Southern Pacific Hospital building into Mercy Terrace as housing for seniors. This project spurred her interest in the develop-

sity of San Francisco School of Nursing. In 1999 The Non-Profit Housing Association of Northern California honored her with its Lifetime Achievement Award. The National Low Income Housing Coalition presented her with its leadership award in 2006. In 2009 she was inducted into Affordable Housing Finance’s Hall of Fame, and in 2017 she was honored with the Dignity Award at the celebration of Mercy Housing’s 35th anniversary.

KEEPING UP PRESIDENTS/CEOS

Organizations within St. Louis-based Ascension have made these changes: John Baird to chief executive of AMITA Health Saint Joseph Hospital Chicago, from president and chief executive of MetroSouth Medical Center in Blue Island, Ill. Dawn Rudolph to president of Sacred Heart Hospital Pensacola, Fla., from president and chief executive of Ascension’s St. Vincent’s Medical Center in Bridgeport, Conn. Facilities within Providence St. Joseph Health of Renton, Wash., have made these changes: Seth R. Teigen to chief executive of Mission Hospital, which has campuses in California’s Mission Viejo and Laguna Beach. Teigen was president of Ascension Southeast Wisconsin Hospital — Franklin Campus in Franklin, Wis., and Ascension St. Francis Hospital in Milwaukee. Randall Castillo to chief executive of St. Mary Medical Center in Apple Valley, Calif., from chief operating officer of Northwest Texas Healthcare System in Amarillo, Texas.

Dr. T. Steen Trawick to chief executive of CHRISTUS Shreveport-Bossier Health System of Shreveport, La., from associate chief medical officer for Sound Physicians, the independent physician staffing company that has a contract to provide some physician management services at CHRISTUS Shreveport-Bossier. Trawick replaces Isaac Palmer, who departed July 1. John L. Wagner to president and chief executive at HSHS St. Joseph’s Hospital in Chippewa Falls, Wis., effective Sept. 30. He was director of operations for Jones Regional Medical Center in Anamosa, Iowa. Paul Hiltz is departing as chief executive of Mercy Medical Center of Canton, Ohio, to accept a position with NCH Healthcare System, in Naples, Fla. Hiltz will depart Aug. 30. Thomas J. Strauss, president and chief executive of Cleveland-based Sisters of Charity Health System, will take on the additional role of interim chief executive of Mercy Medical Center, one of the health system’s two Catholic hospitals in Ohio.

Essentials for Leading Mission in Catholic Health Care

For New Mission Leaders!

The Chase Park Plaza Royal Sonesta Hotel St. Louis

Essentials for Leading Mission in Catholic Health Care is designed specifically for new mission leaders and those considering entering the ministry of mission integration to assist their growth in the competencies necessary to be effective in their roles.

The program will start at approximately 1 p.m. on Monday, Sept. 9, and conclude by noon on Wednesday, Sept. 11.

The in-person program will be followed by a series of online meetings, approximately every two months starting in November. The topics covered in the online meetings will include

In-Person Meeting SEPT. 9 – 11, 2019

international outreach, community benefit and advocacy as well as subject areas the cohort group will determine.

Online Zoom Meetings, 12:30 – 2 p.m. ET NOV. 12 MAY 12 JAN. 14 JULY 14 MARCH 10 ®

The registration cost covers both the in-person meeting and online meetings, with the series concluding in the summer of 2020.

OBJECTIVES After completion of this program, participants will be able to: !

Express trends in mission

pply the Ethical and Religious A Directives for Catholic Health Care Services

escribe the mission leader’s D role in spiritual care and workplace spirituality

leader competencies and organizational roles

Interested parties should direct resumes to: Cara Brouder, Senior Director, Human Resources Catholic Health Association 4455 Woodson Rd. St. Louis, MO 63134 Phone: 314-427-2500 For consideration, please email your resume to HR@chausa.org

ment of low-income housing. “People sometimes think of not-forprofit housing as charity,” Sr. Murphy said at a Mercy Housing property dedication. “It’s not charity. It’s justice. People have a right to safe, affordable housing. We are not just dealing with bricks and mortar. We are dealing with human lives. We want to be known for compassionate competence.” In 1998 she received an honorary doctorate of humane letters from the Univer-

rticulate a fundamental A theological grounding for the work of mission and framework for the Catholic health ministry xplain Catholic social teaching E relating to health care

I dentify timely issues, practices and resources in pastoral care and ministry formation

rticulate the role of the mission A leader in business decisions including strategic planning, budgeting and operations

escribe the mission leader’s D role in community benefit

S hare the importance of international outreach as part of the organization’s mission

LEARN MORE AT CHAUSA.ORG/EVENTS

CATHOLIC HEALTH WORLD August 15, 2019

SSM Health hospitals offer dolls to patients with dementia to calm them Program director studying lifelike toys’ impact on fall incidents By JULIE MINDA

Courtesy of KTVI FOX 2

t can be a challenge for hospital staff to keep patients with advanced dementia secure and content. If patients are restless, disorientated or confused, and are unable to understand or follow instructions, it can be difficult for staff to ensure they don’t try to get up out of bed unassisted. This agitation can increase the risk of falls and other adverse events for patients with dementia, according to Angie Filipiak, director of women’s services at SSM Health St. Clare Hospital in Fenton, Mo. To help reduce Filipiak the risk of accidents and to promote restful recovery, six SSM Health hospitals in Missouri are implementing a creative solution: They are offering lifelike baby dolls to patients with dementia. According to information from SSM Health, the dolls “can bring a feeling of companionship, an improved sense of well-being and a decrease in negative emotions and agitation” for patients. Filipiak is leading a study to determine whether the use of the dolls also decreases the risk of falls among patients with dementia. She came up with the idea for the doll therapy program about two years ago. Formerly a pediatric nurse, she’d transferred to St. Clare to head an adult medicalsurgical unit. She quickly realized what a challenge staff were having trying to keep surgical patients with dementia safe. It was not uncommon, Filipiak says, for staff to give such patients simple tasks, such as folding towels, to focus the patients’ minds so they’d be less likely to become disconcerted and try to get out of bed or a chair unassisted. In 2017, Filipiak and a colleague noticed that a patient with impaired cognition was cradling a towel as if it were a baby. The patient seemed to relax caring for her towel baby. Filipiak’s daughter had a brand-new spare doll at home and she brought that doll in to give to the patient. But the patient was so content with the towel that Filipiak left the doll in her office. Several months later when another patient with dementia became extremely restless, Filipiak suggested the care team offer the patient the

Angie Filipiak, foreground, and Aldijana Sacic of SSM Health St. Clare Hospital in Fenton, Mo., visit with Dieter Deuchler, who was given a comfort doll during his hospitalization in April 2018. Deuchler has since died. Filipiak founded SSM Health’s doll therapy program. Both she and Sacic are nurses.

baby doll. “We were amazed how quickly it calmed her. She would talk to the doll, and this calmed her,” Filipiak recalls. The experience inspired Filipiak to launch the doll therapy program and a related research study on the dolls’ impact on fall risk. She’d seen research — most of it conducted in long-term care settings — that indicated that doll therapy can reduce behavioral symptoms associated with dementia, but Filipiak hadn’t seen anything on its impact on falls. Filipiak bought lifelike baby dolls, with eyes that open and close. Her purchases included boy dolls and girl dolls and dolls representing a variety of races. The program expanded to the emergency room and all inpatient units at St. Clare in October. The units try to keep three or four dolls on hand. The hospital auxiliaries and leadership at St. Clare and five additional participating SSM Health hospitals are providing most of the money to purchase the dolls. The staff treats each doll as if it is a real baby — presenting the doll swaddled in a receiving blanket and patting the doll’s back as they present it to the patient. “To see the response of the patient when they receive the doll — they light up with a sense of joy,” Fili– piak says. Many patients name their dolls. Some patients keep the doll in their hospital bed. The dolls can

Baby dolls used in the doll therapy program at SSM Health St. Clare Hospital.

go home with the patients upon discharge. (Dolls are not reused, due in part to infection control concerns.) Filipiak’s initial research in St. Clare’s med-surg unit ran from March 2018 to May 2018. It involved 35 patients with dementia. Filipiak documented an 85 percent reduction in behavioral symptoms — including restlessness and agitation — after patients received the dolls. To assess whether having a doll reduced fall risk, Filipiak pulled the fall reports on all patients with dementia who had been in the medical-surgical unit between March 2017 and May 2017. There were four falls recorded for that control group, but no falls involving the 35 patients who were given dolls. The patients have a sense of purpose and serenity when car-

ing for the dolls, Filipiak says. She says this is true whether or not the patients believe them to be dolls or real babies. Filipiak recalls the experience of one patient with dementia who was hospitalized at St. Clare as she approached the end of her life. She was so restless she had to be kept in restraints. When given a doll, the patient became tranquil. She named the doll “Heidi” after one of her grandchildren. “The patient passed in the hospital peacefully unrestrained and the family was so appreciative — they were going to bury their mom with the doll,” Filipiak says. Filipiak now is heading a broader iteration of the study. She has engaged the six SSM Health hospitals in the doll therapy program in her research. Staff will observe and record the impact of the doll therapy on symptoms

related to fall risk such as agitation and restlessness, attempts to get out of bed without assistance, and wandering. “While other factors and interventions like bed/chair alarms and fall mats are utilized and essential to prevent falls and falls with injury in this patent population, the dolls are an additional intervention that will help reduce agitation, restlessness (and) wandering and provide more comfort, which will put these patients at a lower fall risk,” says Filipiak. The anecdotal results are positive so far, Filipiak says. Nurses like having “another tool in their toolbox” to use in response to behavioral symptoms, before they must resort to medications, or as a last choice, restraints. Medications can cause side effects that can increase fall risk, with the elderly especially prone to these side effects. There now are some physicians at St. Clare who will not place an order for behavior control medications, such as antipsychotics or calming agents such as benzodiazepines, until the care team has tried doll therapy first with their geriatric patients with advanced dementia, she says. Filipiak plans to develop a tool kit on how to roll out a doll therapy program, and she hopes to expand the program to other hospitals, even beyond SSM Health. She welcomes inquiries at doll therapystclare@ssmhealth.com.

A star is born Babies born at Dignity Health – St. Rose Dominican hospitals are getting a high-profile public debut in the Las Vegas area. COMMONSPIRIT The hospitals are running HEALTH their birth announcements on three digital billboards along a busy highway so that they can “share the joy of a new baby with the rest of our community.” At left is an illustration. Parents of babies born at St. Rose Dominican’s Siena and San Martín campuses can opt for their baby’s announcement to appear on the 14-feet by 48-feet billboards along Interstate 215, which runs near the hospitals. The Siena campus is in Henderson, Nev., and the San Martín campus, in Las Vegas.