Catholic Health World - November 1, 2019 by Catholic Health Association

Ministry leads in palliative care 2 Keeping Up 7 PERIODICAL RATE PUBLICATION

NOVEMBER 1, 2019 VOLUME 35, NUMBER 19

Initiatives are zeroing in on racial disparity in maternal mortality Ministry experts

available to offer guidance on Catholic identity audits

By LISA EISENHAUER

By JULIE MINDA

Courtesy SSM Health

After dramatically reducing the number of women dying from pregnancy-related causes, California is now looking at ways to improve outcomes for black women, who, as a group, are still dying from pregnancy and childbirth complications at a rate about three times higher than the general population. The efforts being led by the California Maternal Quality Care Collaborative are among others across the nation targeting the racial disparity in maternal mortality rates. The collaborative was founded at Stanford University School of Medicine with support from the state of California in response to rising rates of death and profound complication among pregnant women. It counts almost all hospitals with maternity units in the state among its members, including those in the Providence St. Joseph Health and CommonSpirit Health systems. The decrease in maternal deaths in California has come as the rate for the nation has increased. Since 2006, when the collaborative was founded, the California

Early this year, CHA introduced a tool for the association’s representative members called the Ministry Identity Assessment. It is a comprehensive, step-by-step guide for evaluating how well Catholic health systems are living out their mission as a ministry of the Catholic Church. Over the summer, 18 mission and ministry experts underwent CHA training to prepare for assignments as “external assessment observers.” Those individuals can

Nurse Tierra Dean checks on a patient and her newborn at SSM Health St. Mary’s Hospital in St. Louis. The hospital delivers more babies than any other in the SSM Health system. Like other hospitals, it has put vetted practices in place to prevent maternal deaths and complications.

data for the state are available. In contrast, the national maternal mortality rate climbed from 15.7 in 2006 to 17.2 deaths per

Department of Public Health says the rate has dropped 55 percent from 16.9 deaths per 100,000 live births to 7.3 deaths in 2013, the last year for which publicly released

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Our Lady of the Lake in Baton Rouge steps up safety efforts Courtesy Our Lady of the Lake Regional Medical Center

By LISA EISENHAUER

Team members gather in the trauma unit at Our Lady of the Lake Regional Medical Center in Baton Rouge, La., to pray on July 17, 2016, after a shooting in the city in which six law enforcement officers were hit by gunfire. Five of the officers were brought to the medical center for treatment. Three of the officers who were shot did not survive.

When one of their own nurses was fatally shot by an ex-boyfriend outside her home last year, leaders at Our Lady of the Lake Regional Medical Center in Baton Rouge, La., decided to step up their efforts to improve safety for their staff and patients. The attack came as the hospital was seeing an increase in reports of patients, their family members or visitors assaulting its team members, said Coletta Barrett, vice president of mission at Our Lady of the Lake. Our Lady of the Lake set up the Workforce/Workplace Safety Committee at the end of last year, underscoring its determination to act quickly and decisively to keep its workers safe both in the hospital

function as impartial observers and advisers during an organization’s self-audit of mission effectiveness and Catholic identity. Many of the external observers are recently retired or semiretired ministry leaders with expertise in Catholic identity and mission (see sidebar, page 3). CHA is recruiting additional seasoned ministry professionals to train as observers in the identity assessment process. “The goal of the assessment is to have

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Michael McCarthy and Sr. Laura Wolf, OSF, take part in a summer training session at CHA, to prepare to be external assessment observers.

CommonSpirit’s EthicsLab podcast draws listeners across globe Kevin Murphy says he was looking for a way to create health care ethics education that was available anytime and anywhere when he came up with the idea for a podcast. That, in short, is how EthicsLab was born two years ago in a recording studio in Englewood, Colo., with a support team from what was then Catholic Health Initiatives. The monthly production features national and international guests providing knowledge and tools to respond to some of the more challenging issues in clinical ethics, including by identifying the common ground shared by the Catholic ethical and social justice tradition and public debate on health care ethics issues.

Courtesy CommonSpirit Health

By COLLEEN SCHRAPPEN and LISA EISENHAUER

Kevin Murphy, right, interviews Brian Yanofchick for a podcast. Murphy is senior vice president of mission innovation, theology and ethics at CommonSpirit Health and host of its EthicsLab and other podcasts. Yanofchick is chief sponsorship officer, Atlantic Group, for Bon Secours Mercy Health.

Murphy taps leaders both within and outside of Catholic health care ethics as podcast guests. Each EthicsLab episode has discussions by a panel of subject experts who offer practical advice and tools to improve patient care and frame what Murphy calls “tough choice ethical challenges.” Titles of EthicsLab episodes include “Organ Donation: Foundational Ethical Approaches,” “Human Trafficking” and “Moral Distress and Moral Resiliency.” Murphy says he strives to make the podcast conversations relevant and inclusive of those who come from a diversity of backgrounds. “Any conversation on human dignity crosses whatever tradition or experience you may come from,” he says. The podcast “gives us that ability to interview and engage high-quality experts Continued on 6

CATHOLIC HEALTH WORLD November 1, 2019

Catholic hospitals out front in palliative care services Palliative care map shows that where patients live determines access to supportive care

Where you live matters WA

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IL CO

TN MS

NJ DE

CT RI

MD DC

SC AL

State grade by color 80% or more 60%–79%

40%–59%

20%–39%

Source: Center to Advance Palliative Care (CAPC)

palliative care to people with serious illness. In 2019, almost three in four do. The outliers are largely for-profit, with only 35 percent of that sector providing palliative care, and rural hospitals, with only 17 percent offering such care, according to the report. While patients living in Northeastern states are likely to have ready access to hospitals with palliative care services, patients living in South Central states may have a much harder time accessing palliative care. For instance, the report found that fewer than one in three hospitals in Alabama and Mississippi have palliative care teams. “This geographic limitation in access is not limited to palliative care,” Meier said. “It’s true of many other aspects of access to health care that geography is destiny, that where you live largely determines what care you have access to.” Meier said there is a growing body of

Best and worst states for palliative care access Top five states for palliative care and their grades from the Center for Palliative Care 1. New Hampshire (A) 100.0% [tie] 1. Rhode Island (A) 100.0% [tie] 1. Vermont (A) 100.0% [tie] 1. Delaware (A) 100.0% [tie] 5. Connecticut (A) 95.8% Bottom five states for palliative care 47. Alabama (D) 39.3% 48. New Mexico (D) 38.5% 49. Oklahoma (D) 37.5% [tie] 49. Wyoming (D) 37.5% [tie] 51. Mississippi (D) 33.3%

evidence that, in addition to improving the quality of life of patients with chronic disease, palliative care lowers health care costs, “so it is the exemplar of high-value medical intervention.”

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Hospital Palliative Care Grades by State 2019

By LISA EISENHAUER

When it comes to palliative care, Catholic hospitals continue to lead the way, according to the Center to Advance Palliative Care. The center recently released a report, “America’s Care of Serious Illness: 2019 State-by-State Report Card on Access to Palliative Care In Our Nation’s Hospitals,” that looked at nonfederal hospitals with 50 or more beds. Of those, the center found that 91 percent of Catholic hospitals offer palliative care, compared to 72 percent of ospitals overall. “The Catholic hospitals have been way ahead of the rest of the hospitals since we started measuring and remain there,” Dr. Diane E. Meier, the center’s director, said at Meier the release of the report in early October. She summarized the report and took questions in a web broadcast from Capitol Hill. The center, part of the Icahn School of Medicine at Mount Sinai in New York City, has issued “report cards” on palliative care in the U.S. every four years since 2001. Meier, a professor of geriatrics and palliative care medicine at the Icahn School, helped shape the field of palliative care and she has championed its adoption by hospitals and providers to address the physical and psychological suffering of patients at every stage of serious chronic illness. The report found much improvement since 2001 when only 7 percent of hospitals had programs to provide team-based

Since the report was last released in 2015, the percentage of hospitals with palliative care programs has climbed to 72 percent from 66 percent. Meier sees hopeful signs for continued expansion of access to palliative care. For one thing, a change in federal rules has opened the door to coverage of homebased palliative care by Medicare Advantage providers. In addition, Sens. Jacky Rosen, D-Nev.; John Barrasso, R-Wyo.; Deb Fischer, R-Neb.; and Tammy Baldwin, D-Wis., formed the Comprehensive Care Caucus this summer and pledged to raise awareness of, promote access to and improve the quality of palliative and coordinated care. Meier is optimistic that the caucus and others will address what the Center to Advance Palliative Care sees as gaps, such as too few palliative care specialists being trained, inadequate fee-for-service payments from insurers and a lack of meaningful measures of quality care. For inspiration on how to get palliative care to more of the 12 million adults and 400,000 children living with a serious illness, such as cancer, heart disease, kidney disease, or dementia, Meier said policymakers could look to states like California, which recently made it legal for licensed hospices to provide palliative care to nonhospice patients, or Maryland, which passed a law requiring hospitals with over 50 beds to establish programs that meet quality criteria. To offer tips on how to leverage the report’s findings and recommendations, the center started a blog called Palliative in Practice. It launched in October at capc. org/blog/. “How do we make progress toward a world where when you go to the hospital you can assume that a reasonably highquality palliative care service is there?” Meier asked. “In order to get that done, we need policy change.”

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November 1, 2019 CATHOLIC HEALTH WORLD

Ministry Identity Assessment

The tool calls for scoring to follow criteria established by the Baldrige Performance Excellence Program.

From page 1

continuous quality improvement around the core commitments of Catholic health care,” said Brian Smith, CHA vice president of sponsorship and mission services. And, in addition to providing fresh perspectives and wisdom, the outside observers can help ensure the identity assessment process is proceeding on track and that it will deliver useful, actionable information, Smith said.

Core commitments The Ministry Identity Assessment is built around seven core commitments of Catholic health care (see sidebar), with senior leadership commissioning the audit for their facility or system and deciding which core commitments to focus on and whether external assessors will be used. (CHA recommends that members who elect to use external review include at least two trained observers in the process. Organizations are Seven core commitments of Catholic health ministry As the church’s ministry of health care, we commit to: Promote and defend human dignity Attend to the whole person Care for poor and vulnerable persons Promote the common good Act on behalf of justice Steward resources Serve as a ministry of the church Source: CHA’s “A Shared Statement of Identity for the Catholic Health Ministry”

Catholic health care experts take part in a summer training session at CHA’s St. Louis office, led by CHA staff. The session prepared the experts to serve as external observers for the Ministry Identity Assessment process.

Many uses Smith says ministry organizations will find the assessment tool useful not only for continual quality improvement and formation purposes but also for keeping interested parties attuned to the workings of the organizations. The assessment results can be used as part of usual reporting to local bishops to confirm the Catholic identity of organizations. The results can be woven into periodic updates and reports that systems sponsored by a public juridic person make to the Vatican. The results also can be reported out to local community members, to help them understand how providers are living out their Catholic identity. Observers Host organizations that employ external observers contract with those individuals directly, agreeing to pay a daily fee of $1,000 for each observer plus all travel-related expenses. In general, observers will hold two conference calls and make one on-site visit with their client organizations. The time commitment for the observers likely would be three to four days per audit, said Smith. In addition to providing input during their visit, the external observers will submit a report to their client within two weeks after their visit, which the host facility will use when finalizing its analysis. More information about the assessments and observers is available at chausa. org/ministry-identity-assessment.

encouraged to select individuals whose expertise is most aligned with a system or facility’s needs and goals.) Early in the Ministry Identity Assessment process, senior leaders of the organization undergoing the mission audit will identify 12 to 15 people to be a part of a steering team. Normally headed by a mission executive, that steering team will drive much of the information gathering and assessment process. CHA’s manual proposes a sevenmeeting format to lay the foundation for the work, to form the people carrying out the assessment, to oversee a rigorous examination of the entire organization through the lens of the selected core commitments, to assess findings and ultimately derive a “consensus score” in each area, and to make plans for improvements, as necessary.

Ministry Identity Assessment external observers

Sr. Carey

Connelly

Doyle

Eldridge

Hamel

Kuczewski

Kuramoto

Lysaught

McCarthy

Middleton

Mudd

Fr. Nairn

O’Brien

Ponzetti

Rocole

Sr. Talone

Thompson

Sr. Wolf

Sr. Judith Carey, RSM Member of the board of the Connecticut Hospital Association; in private practice as a facilitator and organizational consultant; past president of the Sisters of Mercy of Connecticut; doctor of philosophy in educational psychology Michael Connelly Past president and chief executive, Mercy Health; life fellow, American College of Healthcare Executives; past CHA board chair; doctor of law; master’s degree in health services administration Michael Doyle Retired vice president of mission for Mercy Health, St. Louis; master of divinity Cathy Eldridge Principal of Eldridge Consulting and chief operating officer of Trio Labs; current CHA board member; master of business administration Ron Hamel Member of SSM Health Ministries, the public juridic person of SSM Health; member of the SSM Health Board of Directors; former senior ethicist, CHA; doctor of philosophy in moral theology; master of arts in systematic theology

Mark Kuczewski Professor of medical ethics and director of the Neiswanger Institute for Bioethics and Healthcare Leadership, part of Loyola University Chicago; doctor of philosophy Dr. Robert Kuramoto Managing partner of Quick Leonard Kieffer; past CHA board member M. Therese Lysaught Professor at Loyola University Chicago’s Neiswanger Institute for Bioethics and Healthcare Leadership and director of that institute’s health care mission leadership graduate program; doctor of philosophy in religion and theological ethics; master of arts in theology Michael McCarthy Assistant professor, Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine; doctor of philosophy in thoeology; certified health care ethics consultant Carl Middleton Retired interim senior vice president for mission and ethics, Catholic Health Initiatives, Texas division; and former vice president of theology and ethics for CHI; doctor of ministry; doctor of naturopathy; master of

divinity; master of religious education; master of arts in ethics Jack Mudd Consultant, president’s office, Providence St. Joseph Health; doctor of the science of law; doctor of law Fr. Tom Nairn, OFM Provincial minister, Franciscan Province of the Sacred Heart; former senior director, theology and ethics, CHA; doctor of philosophy Dan O’Brien Retired senior vice president, ethics, discernment and church relations, Ascension; doctor of philosophy in health care ethics; master of arts in systematic theology Rosanne Ponzetti Economic and community development program manager, Clark College; former system vice president of mission integration, PeaceHealth; master of arts in health care administration–Catholic health care leadership; master of science in family studies Terri Rocole Retired chief mission integration officer, Ascension Wisconsin; master of business administration; master of education in ministry

Sr. Pat Talone, RSM Retired CHA vice president for mission services; consultant in ethics, mission, leadership formation; doctor of philosophy in theological ethics Tom Thompson Past president, Allina Health Regina Hospital; master of public health in community health planning and administration Sr. Laura Wolf, OSF Member of the Franciscan Missionaries of Our Lady Health System Board of Directors, Baton Rouge, La.; retired president of Franciscan Sisters of Christian Charity Sponsored Ministries of Manitowoc, Wis.; and sponsor liaison and consultant to the president for sponsorship, for FSCC Sponsored Ministries; doctor of law; master’s in health administration; past CHA board member

CATHOLIC HEALTH WORLD November 1, 2019

Maternal mortality From page 1

100,000 live births in 2015, according to the Centers for Disease Control and Prevention. But in both California and the nation, pregnancy-related deaths among black woman remain nearly three times the overall rate.

Laurie Skrivan/St Louis Post-Dispatch/Polaris

Data driven Cathie Markow, the collaborative’s administrative director, says data analysis indicates that the disparity in the rates are not explained by risk factors such as obesity or high blood pressure. The collaborative’s website cites data that shows “even in the absence of risk factors such as age over 35 years, lack of health

It’s clear that the racebased disparity in maternal deaths is tied to equity of care within the health care system at large. — Dr. David Lagrew insurance, inadequate or no prenatal care and less than high school education, the U.S. system of health care is not protecting Black mothers and birthing people from experiencing higher numbers of deaths or life-threatening complications during pregnancy and childbirth.” “That data starts to suggest that the usual suspects are not the driver and it is impossible to avoid the idea that there is racism at play within (health care) institutions that needs to be addressed,” Markow says. To specifically target the disparity, the collaborative this year launched an initiative called the California Birth Equity Collaborative, a partnership with hospitals, advisory groups and community-based organizations led by black women. The goal of the initiative is to “improve care, experiences, and outcomes for, by and with black mothers and birthing peo-

Registered nurse Elizabeth Mueller steadies newborn Blaike Jackson on the chest of his mother, JaiDa’h Jackson, just after his birth at SSM Health St. Mary’s Hospital in St. Louis, in June 2017. The hospital is among many that use multiple measures, such as cesarean section rates, to judge if its efforts to improve outcomes for pregnant women are working.

ple during hospital births,” according to its website. Its work product is expected to identify best practices for hospitals and knit together clinical and sociocultural interventions by community-hospital partnerships.

Models of success Dr. David Lagrew is the executive medical director and executive leader of the Women and Children’s Services Lagrew Institute for the Southern California region of Providence St. Joseph Health. He is on the executive committee of the California Maternal Quality Care Collaborative. He says the equity collabor-

ative is setting up a two-year pilot study on disparities in maternal mortality that will involve several hospitals and test potential interventions to improve pregnancy outcomes for black women. Exactly what those interventions will be is still being decided. Lagrew says it’s clear that the racebased disparity in maternal deaths is tied to equity of care within the health care system at large. “It really does get back to care and how we counsel patients and how we listen to patients,” he says. “There are some real lessons to be learned.”

SSM’s efforts Like those in California and elsewhere around the country, hospitals in the

St. Louis-based SSM Health system have put special practices in place to prevent birth-related deaths and complications. “We’ve developed order sets, we’ve developed protocols, we developed education for staff, we do simulations to learn to treat this stuff,” says Pam Lesser, nursing director of perinatal services at SSM Lesser Health St. Mary’s Hospital in St. Louis. Lesser says St. Mary’s has been the lead in initiating those practices and resources for SSM Health’s four-state system because it handles more deliveries than any other hospital in the system — about

Linking racism, health outcomes is not novel; report urges better maternal care T

he idea that race plays a role in health outcomes is not a new one. In August 2000, Dr. Camara Phyllis Jones laid out a theory about racism affecting health care in an article called “Levels of Racism: A Theoretic Framework and a Gardener’s Tale” in the American Journal of Public Health. A link to her article is posted on the website of the California Birth Equity Collaborative, which is looking at what’s causing black women to die from childbirth complications at a much higher rate than others and how to prevent it. Jones’ article identifies three forms of racism: Institutionalized: defined as differential access to the goods, services and opportunities of society by race. This form is “often evident as inaction in the face of need,” says the article. Personally mediated: prejudice in which differential assumptions about the abilities, motives and intentions of others are made according to their race and discrimination in which differential actions are taken toward others because of their race. Internalized: an acceptance by members of the stigmatized races of negative messages about their own abilities and intrinsic worth. Race itself is a societal classification that serves as “a rough proxy for socioeconomic status, culture and genes” but not a biological one that “reflects innate differences,” wrote Jones, who has worked at the Harvard School of

Public Health and the Centers for Disease Control and Prevention and is now a senior fellow at the Morehouse School of Medicine in Atlanta. “For this reason, some investigators now hypothesize that raceassociated differences in health outcomes are in fact due to the effects of racism,” Serena Williams: What my life-threatening experience taught me about ... Serena Williams writes that her own childbirth experience taught her we Jones wrote. must work harder to ensure every mother and child have access to ... Racism’s potential impacts on health outcomes is A Twitter post by Serena Williams shows her and her baby daughter, Alexis also a part of more Olympia Ohanian Jr., and urges support for a UNICEF initiative aimed at improvrecent reports, ing health care for mothers and newborns. The photo was posted about a including “Eliminat- month after Williams went public with the story of her own difficult pregnancy ing Racial Dispariand complications. ties in Maternal and in New York. Despite her Infant Mortality,” released in May by a proreport’s grim findings, she gressive think tank, the Center for American sees hope that more black Progress, based in Washington. In linking mothers like herself will racism and the much poorer pregnancy thrive in the future. outcomes of black women, the report cites For one thing, the topic statistics that show black women face more has gotten national attenbarriers, such as lower income and lack of transportation, than others to quality care. tion in recent years. Taylor Taylor Jamila Taylor is the lead author of the points to tennis superstar report. She is now director of health care Serena Williams revealing her ordeal after reform and senior fellow at The Century the birth of her daughter in 2017. In an interFoundation, a progressive think tank based view with Vogue magazine, Williams said

her own knowledge about her health history of blood clots was at first dismissed by clinicians when she complained of shortness of breath the day after she underwent a cesarean section. Williams said that it was only because she insisted on a CT scan that her suspicion of a pulmonary embolism was confirmed and the proper treatment given. Taylor says the “Lost Mothers” investigation on maternal care and preventable deaths produced in 2017 and 2018 by the nonprofit ProPublica news service and National Public Radio also put a spotlight on the poor care provided in some hospitals that serve mostly minority women. “I think that series as well as Serena Williams telling her story really launched the issue into the public consciousness in a way I had never seen before,” Taylor says. Taylor wants her report to be a plan of action. It suggests policy strategies including addressing maternal and infant mental health; ensuring supports for families before and after birth; and improving data collection and oversight. “I’m hopeful the blueprint will be used by both the federal and state policy makers to inform solutions that they will put forward to address this issue and not only put forward or propose, I want to see things passed,” she says. — LISA EISENHAUER

November 1, 2019 CATHOLIC HEALTH WORLD

3,300 a year — and because of its designation as a high-risk pregnancy referral center. The impact of efforts to reduce the maternal mortality rate are hard to track, Lesser and others say, because even though it’s a huge cause for concern, the number of women who die due to pregnancy is not itself huge (about 700 a year across the nation) and the annual figures don’t come out quickly in part because under CDC rules the rate includes deaths up to a year after delivery. St. Mary’s is among many hospitals using multiple measures to judge if its efforts are improving outcomes for pregnant women. Those measures include looking at how much time birth mothers spend in the intensive care unit, how many undergo cesarean sections and how much blood is transfused to them.

“That data starts to suggest that the usual suspects are not the driver and it is impossible to avoid the idea that there is racism at play within (health care) institutions that needs to be addressed.” — Cathie Markow

Photos courtesy Providence Holy Cross Medical Center

disparities in health outcomes for mothers, Lesser believes that care providers need to have the social competence to relate to patients of various races and ethnicities. But she also believes that factors beyond the reach of hospitals are at play. She cities social determinants like access to care, insurance coverage and transporCommunity effort When it comes to addressing the racial tation. “Those are really big issues that we are absolutely part of working on,” she says. The hospital has partnered in various community initiatives to address racial equity overall in the St. Louis region. For example, it is part of a coalition called Generate Health that is trying to “advance racial equity in pregnancy outcomes, family well-being, and community health” by bringing resources to bear on issues effecting vulnerable mothers and babies. The organization runs tours in lowincome communities to give medical and nursing students a visceral understanding of how poverty and racism impact upon health inequities. Susan Kendig, women’s health integration specialist at St. Mary’s, has had a lead role in the develA lifelike manikin is used in simulation training on an emergency opment of pregnancyrelated best practices by delivery at Providence Holy Cross Medical Center in Mission Hills, the Council on Patient Calif.

Pregnancy-related deaths, by sociodemographic characteristics Characteristic Total

Number of pregnancy- Pregnancy-related related deaths mortality ratio* 3,410 17.2

Race/Ethnicity* (N = 3,400) White Black American Indian/Alaska Native Asian/Pacific Islander Hispanic

1,385 13.0 1,252 42.8 62 32.5 182 14.2 519 11.4

*Note: Number of pregnancy-related deaths per 100,000 live births per year. Source: Preganancy Mortality Surveillance System, United States, 2011-2015

Trends in pregnancy-related mortality in the United States: 1987 – 2015

*Note: Number of pregnancy-related deaths per 100,000 live births per year. Source: Centers for Disease Control and Prevention

Safety in Women’s Health Care and the Alliance for Innovation on Maternal Health. Both are national initiatives supported by professional organizations. AIMH is also supported by the Kendig federal Health Resources and Services Administration. Their recommendations include mental health care and transitioning from maternal to well-woman care. They encourage “a community-wide effort that includes hospitals, clinical providers and community organizations and patients with lived experience to work together to address maternal mortality,” Kendig says. “Reduction of Peripartum Racial/ Ethnic Disparities,” one of the council’s “patient safety bundles,” recommends providers:

Establish systems to accurately document self-identified race, ethnicity and primary language. Provide staff-wide education on peripartum racial and ethnic disparities and their root causes and on best practices for shared decision-making. Engage diverse patient, family and community advocates who can represent important community partnerships on quality and safety leadership teams. “That bundle is designed to be overlaid over all of our work,” says Kendig. Like Lesser, Kendig says attempts to end racial disparities in health care have to go beyond clinical settings to succeed. She believes communities have to unite to address issues related to access and equity. “You cannot do this if you’re only looking at health care providers,” Kendig says. leisenhauer@chausa.org

Collaborative’s recommendations inform care at Providence Holy Cross W

hen a patient deemed to be at high risk for hemorrhage checks into the maternity unit at Providence Holy Cross Medical Center, a crash cart is parked outside the mother-to-be’s door. The obstetrics team knows what’s in it, where everything is located and how to use every item in the event of a life-threatening bleed, according to Julie Masson, a registered nurse who is the perinatal simulation educator at the hospital in Mission Hills, Calif. Holy Cross is part of Providence St. Joseph Health, which operates hospitals and clinics in seven states. The crash cart contains every item recommended in the California Maternal Quality Care Collaborative’s guidance on maternal hemorrhage. “We base everything we do off of their recommendations,” says Masson. Masson credits the collaborative’s work for the decrease in maternal mortality and morbidity numbers across the state in recent years. “Everything they present is based on research and best practice,” she says. “It’s easy to see that by following these guidelines, we are providing the safest and best possible care for our mothers.” Dr. David Lagrew, executive medical director and executive leader of the Women and Children’s Services Institute for the Southern California region of Providence St. Joseph Health, credits the use of the collaborative’s resources and training guidance throughout the system for contributing to the fact that the system had no deaths from birth-related complications in 2017 among the 75,000 women who delivered at its hospitals. The collaborative and Providence St. Joseph follow the Centers for Disease Control and Prevention definition of maternal mortality, which covers deaths of mothers up to 12 months after giving birth “from any cause related to or aggravated by the pregnancy.” The care collaborative’s administrative director, Cathie Markow, says that in addition to creating resources to help train maternity specialists in how to handle emergencies, the organization is urging hospitals to educate emergency room staffers to watch for warning signs of potential complications, such as moderately high blood pressure as an indicator of stroke risk, when treating pregnant patients and patients who are postpartum. Markow says a national initiative called Alliance for Innovation on Maternal Health is developing more resources specifically for emergency department staff to heighten their awareness of subtle warning signs and patients’ self-reporting

A cart outfitted with items that might be needed in a maternal emergency is part of the simulation training at Providence Holy Cross Medical Center in Mission Hills, Calif.

of confounding symptoms like a sense that something is not right. Masson says Holy Cross obstetric team members drill on the California collaborative’s recommendations during trainings using high-fidelity manikins to simulate delivery room emergencies, such as hemorrhages, preeclampsia and cardiac arrests. “We like to practice ‘in-situ,’ which means that we conduct our simulations in the patient care environment, such as in a patient room,” Masson says. “This is a really great way to train and practice because staff use the equipment and supplies that they are used to, and it allows us to uncover latent safety gaps.”

Speak up Those gaps can include having supplies stowed in places where they are too hard to get to in an emergency or weaknesses in the lines of communications, such as staffers being reluctant to speak up when they are unclear on an order. “We are always talking with our teams about closing the loop,” Masson says. “If you’re not sure what you heard or you don’t agree with something, then you want to speak up and clarify what you heard. This is called closing the loop in communication.” Masson says the main benefit of the resources provided by the collaborative and the training that puts them into practice at Holy Cross is quicker and more effective responses to maternal emergencies, resulting in more lives saved. “It boils down to the decrease in the delay of care: identifying patients at risk, recognizing signs and symptoms of complications and responding without hesitation,” Masson says. — LISA EISENHAUER

CATHOLIC HEALTH WORLD November 1, 2019

Ethics podcast From page 1

on various issues and make it really accessible to listeners,” says Murphy, who is senior vice president of mission innovation, theology and ethics at CommonSpirit Health. That ministry system formed in January 2019 from a merger of CHI and Dignity Health. The podcast has even spawned an offshoot called EthicsLab Essentials that, paired with a discussion guide created by a team of ethicists from CHI and five other ministry health systems, can provide continuing medical education credit for doctors and continuing education unit credit for other health care professionals.

Bridging traditions Initially envisioned as a way to educate clinicians and administrators within CHI on ethical issues, EthicsLab has attracted a global audience via the Internet, Murphy says. Analytics show people in Canada, Australia, Germany and India are listening. “We didn’t expect or plan for that,” he says. Downloads of the podcasts went from a trickle in the first few months to the low thousands per episode by early October, says co-producer Russell Keithline. Murphy credits timely topics, articulate experts and positive word-of-mouth in professional networks for the steady climb in listenership. Nate Hibner, a director of ethics at CHA,

says he sees two specific benefits to having a podcast that delves into ethics in Catholic health care: bridge-building and awareness-raising. A podcast can connect people involved in and Hibner affected by health care decisions — patients, providers and ethics committees — who may not always understand each other’s concerns. “A podcast could be used as a starting point for education on difficult subjects,” Hibner says. And, for ethicists in Catholic health care, those subjects are expanding beyond clinical health care into socioeconomic factors that help explain why the poor have worse health outcomes, says Fr. Charles Bouchard, CHA’s senior director of theology and sponsorship and a past guest of the podcast. “In the past, we just focused on taking care of sick people. Now we Fr. Bouchard look at the root causes of chronic illnesses, and can we prevent them in the first place? We focus on the socioeconomic determinants of health — poverty, racism, lack of education — and how they contribute to bad health,” says Fr. Bouchard. Technological and scientific advances in medicine introduce a host of issues to consider, including genetic medicine and

genetic counseling. “Podcasts can offer a new dimension in the continuing education of ethics,” Fr. Bouchard says. “It’s a more user-friendly way of extending the ethics function into a bigger group of people. We’re all going to face these ethical decisions, and this makes ethical questions accessible to everyone.”

Essentials of ethics Keithline and Murphy say they’ve taken cues from listener surveys and other sources of feedback to choose topics, shorten the episodes from 50 to 35 minutes and develop the EthicsLab Essentials offshoot. EthicsLab Essentials is a series of 30-minute podcasts that cover what Murphy calls “foundational topics” in health care ethics and provide a starting point for a comprehensive “core curriculum” for ethics committee members and clinicians. “EthicsLab Essentials is the attempt to try to offer foundational education,” Murphy says. “So, if you’re a clinician who wants to brush up, or if you’re a new member of an ethics committee, in those 12 episodes it will give you a good diversity of issues to brush up on so that you’re more knowledgeable and able to impact your care or your work.” Murphy worked with four “lead contributors” to create the EthicsLab Essentials podcasts: Rachelle Barina, Wisconsin regional vice president of mission integration at SSM Health; Becket Gremmels, system director of ethics for CHRISTUS

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Health; Mark Repenshek, vice president, ethics and church relations for Ascension; and Alan Sanders, vice president of ethics integration & strategy at Trinity Health. The EthicsLab Essentials podcasts will be reviewed for potential updates every year or two, Keithline says, but the goal has been to frame content that has enduring relevance. The production team created pre- and post-listening testing materials to be used in conjunction with each episode, which allow for the continuing medical education accreditation of EthicsLab Essentials. In addition to helping educate medical professionals, Murphy says the episodes and the tools that pair with them — such as study guides and links to relevant sites and sources on the Internet — are being used by ethics committees at hospitals to spur discussions. Murphy doesn’t rule out additional related ventures or changes to existing formats as producers incorporate constructive feedback from guests and listeners. “We’re always trying to be in conversation with listeners to understand what’s the next evolution that’s going to be helpful,” he says. All episodes of EthicsLab and EthicsLab Essentials can be streamed at mission online.net or downloaded through platforms such as Apple Podcasts and Google Play. leisenhauer@chausa.org

CHA Chief Operations and Finance Officer CHA is seeking a strategic executive aligned with the association’s mission to serve as its chief operations and finance officer. A member of the CHA president’s advisory council, this individual will be accountable for leading key financial and operational functions during a pivotal time for the association, with a recently appointed president and chief executive officer and a new strategic plan under development that will be in effect beginning July 1, 2020. Based in St. Louis and reporting directly to the president/CEO, the chief operations and finance officer will be responsible for the financial and operational vision, and alignment of operations to advance CHA’s strategic priorities and ensure the financial, technology, production and business intelligence functions remain efficient, effective and service-oriented. Strong financial acumen and demonstrated fiscal stewardship are top priorities as this person will be the key staff liaison in support of the association’s finance committee, co-staff for the organization’s audit and compliance committee, and its corporate treasurer. In addition, this person must have a proven ability to build relationships and collaborate effectively with other leaders. Excellent verbal and written communication skills are imperative as well as the ability to maintain integrity, establish credibility, and earn trust and respect. Requests for additional information or nominations should be directed to the consultants supporting this search: Donna Padilla, Jim King, and Wendy Brower c/o WittKieffer 7733 Forsyth, Suite 725 St. Louis, MO 63105 Phone: 314-754-6072 Email: wbrower@wittkieffer.com CHA is an equal opportunity employer.

November 1, 2019 CATHOLIC HEALTH WORLD

KEEPING UP

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Organizations within Bon Secours Mercy Health of Cincinnati have made these changes: Shane Knisley to president of Mercy Yousuf Health – Clermont Hospital of Batavia, Ohio. He was chief operating officer of Mercy Health – Fairfield Hospital of Fairfield, Ohio. Knisley succeeds Justin Krueger, who became president of Fairfield Hospital earlier this year. Ronda Lehman to president of Mercy Health’s Lima, Ohio, market. She was president of Mercy Health – St. Rita’s Medical Center of Lima. She succeeds Bob Baxter, who had been president of the Lima market since 2010 and had assumed the additional role of president of the Toledo, Ohio, market in 2017. Baxter will continue as president of the Toledo market. Faraaz Yousuf to president of the Richmond, Va., market of Bon Secours Mercy Health, effective Dec. 1. He was chief strategy officer of the Bon Secours Mercy Health Atlantic Group. Rod Schlader to president of MercyOne North Iowa Medical Center of Mason City, Iowa, part of Trinity Health of Livonia, Mich. He had been interim president.

Sr. Jasinski

Sr. Davia

ADMINISTRATIVE CHANGES

The Congregation of the Sisters of Bon Secours, at a recent general chapter meeting, elected Sr. Rose Marie Jasinski as its congregation leader. She succeeds Sr. Patricia Eck. Sr. Jasinski had led the Sisters of Bon Secours USA of Marriottsville, Md. The congregation elected Sr. Elaine Davia leader of the Sisters of Bon Secours USA. Sr. Davia was the formation director for the Sisters of Bon Secours. Organizations within Livonia, Mich.-based Trinity Health have made these changes: Dr. Richard K. Freeman to regional chief clinical officer of Loyola Medicine of Maywood, Ill., effective Nov. 4. Karla Zarb to chief nursing officer and vice president of operations at St. Joseph Mercy Livingston in Howell, Mich., and the St. Joseph Mercy Brighton health center in Brighton, Mich. She will continue as executive director of surgical services for St. Joseph Mercy Ann Arbor of Ypsilanti, Mich., and St. Joseph Mercy Livingston. Veronica Martin to chief nursing officer of CHI St. Luke’s Health – Baylor St. Luke’s Medical Center of Houston.

GRANTS

The Saint John’s Health Center Foundation in Santa Monica, Calif., has received a $25 million gift for the Providence Saint John’s Health Center, John Wayne Cancer Institute and Pacific Neuroscience Institute. The anonymous gift is helping kick off the “Power of Partnership Campaign,” a $150 million effort to raise funds for clinical and research programs, faculty, nursing and fellowship support and capital equipment needs. St. Louis County’s Children’s Service Fund awarded a $3.2 million, 30-month grant to Mercy Hospital St. Louis’ Adolescent Intensive Outpatient Program. The program treats patients ages 12 to 19 years old with behavioral, psychiatric and emotional issues. The Children’s Service Fund grant will assist families with insurance in paying for co-pays and deductibles and will allow families without insurance to attend the program free of charge. The Hyland Behavioral Health Center at Mercy Hospital South and Edgewood Behavioral Health at Mercy Hospital St. Louis are the units that provide the Intensive Outpatient Program.

CATHOLIC HEALTH WORLD November 1, 2019

Safety efforts From page 1

and in their personal lives. The committee has since led efforts to rewrite safety policies, expand training programs and launch awareness initiatives intended to keep aggressive encounters from escalating to violence involving employees and to empower and protect employees facing domestic violence. All of the efforts have been undertaken in line with Our Lady of the Lake’s mission to be a spiritual and healing presence, Barrett said. Those efforts took on added urgency this spring when a nurse at nearby Baton Rouge General Barrett Medical Center died from what the coroner said were complications resulting from an assault by a patient in a behavioral health unit. Our Lady of the Lake is part of the Franciscan Missionaries of Our Lady Health System. Baton Rouge General is not part of that system.

Documented dangers Federal statistics show the threat of workplace violence is much higher for health care workers than for other workers. In 2017, the number of nonfatal intentional occupational injuries from assaults nationwide was 18,400, according to the U.S. Bureau of Labor Statistics. Of those, 13,080 were in health care or social service settings. Those numbers have risen steadily since 2011, when the overall number was 11,690 and the number for health care or social service settings was 8,180. Lisa DiBlasi Moorehead, associate nurse executive at the Joint Commission, said the hospital accreditation organization has educational resources on how to respond to violence and its committees have made it a priority to do more work in this area. “It’s not an issue that’s going away,” Moorehead said of violence against health care workers. “We have to define it. We have to evaluate it. We have to measure it. And we

have to provide staff with tools so that they can address it as it occurs.”

Responding to tragedy The safety committee that Barrett is part of at Our Lady of the Lake was formed months after nurse Gabrielle Bessix was murdered outside her home by a former boyfriend in August 2018. The man also shot and wounded a friend of Bessix’ and then killed himself. Barrett said that because domestic violence attacks are affecting workers, the medical center has zeroed in on how it can do more to help team members who are facing threats at home. As part of its response, Our Lady of the Lake has posted information in staff gathering places like break rooms about how victims of domestic violence can get help. In honor of Bessix, it also set up an annual lecture series that bears her name and focuses on safetyrelated topics. Safety at work Barrett said the Workforce/Workplace Safety Committee is charged with reviewing and updating the security measures and safety protocols for the hospital and its satellite centers, and educating workers on them. The hospital’s senior leadership have

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reviewed and supported the changes the committee has recommended and put in place. Barrett said the ER and behavioral health unit have been the scenes of most incidents of aggression at Our Lady of the Lake and she attributes that to the higher states of stress and trauma patients and visitors in those units tend to be under. One of the committee’s initiatives was to post stern warnings to patients and visitors that threatening or aggressive behavior will not be tolerated. “Incidents may result in removal from this facility and possible prosecution and imprisonment,” the warnings state. In addition, the hospital has instituted post-incident reviews, called huddles, following reported episodes of violence. Staffers, who witnessed or were involved in the occurrence, debrief with supervisors and security workers. After one of the first huddles and based on comments from a staff safety survey, Barrett said security staff were moved from behind the triage desk to the middle of the emergency department at the medical center “so people can see that there is law enforcement present.”

Clear policy The committee also has helped the hospital leadership craft a formal policy on how to deal with patients whose behavior is so disruptive that it impedes their care. To start, a team that includes an administrator, an ethics leader and clinical staffers decide if a “behavioral contract” is proper and needed. The contracts are signed agreements with patients who have remained combative, despite being coached and counseled. “It helps them to understand the consequences of continuing to act out,” Barrett said of the contracts. “It could mean discharge.” If the patient doesn’t follow through on the terms of the contract and acts out, the administrator on call determines if an administrative discharge unrelated to the patient’s medical or mental condition is the proper course to ensure staff safety. “Our policy now enumerates the steps that must be taken for an administrative discharge and it includes checks and balances to ensure that the action is being taken appropriately,” Barrett said. She emphasized that both before and after the formal policy was put in place, behavioral contracts and administrative discharges have been rare. Training and education The hospital also has expanded on-site safety and situation de-escalation training, both to provide the training to more staff members and to include more techniques. Outside contractors train hospital staffers as instructors, and those staff members in turn train their colleagues on ways to stay physically safe in various situations. The hospital is using computer-based training to teach workers techniques to calm agitated and potentially aggressive patients. In addition, Our Lady of the Lake now encourages staff to pursue criminal assault charges against assailants. This has included working with the local district attorney’s office to educate staffers on the prosecution

A warning posted in some parts of Our Lady of the Lake Regional Medical Center.

process as well as giving assault victims paid time off to attend any related court hearings. Barrett said that in the past, workers seemed to assume that, since they hadn’t been explicitly told the hospital would support them if they pursued charges after an assault, such incidents were to be taken in stride as part of the job. “That may have been the way it was in the past, but so much has changed and (violence) has become more prevalent,” she said. “We have to be able to communicate to our teams to say, ‘Should you choose … to press charges, we’re here to support you.’” As part of its collaboration with the hospital, beginning about two years ago, the district attorney’s office for the parish that includes Baton Rouge assigned a violence recovery specialist to work out of the medical center’s emergency department, linking violence victims with resources that could help them pursue justice and healing. Kerry Deichmann, who holds that post, said, “I try to address all the physical, emotional and social needs that any victim of violence might face during and after the trauma after being released from the emergency department.” In recent months the hospital began tapping the expertise of the district attorney’s office through Deichmann to help its employees who have been victims of domestic violence or threats. Barrett said Our Lady of the Lake wanted its team members to know what resources the district attorney’s officer could provide and what their rights as victims are. So far, Deichmann hasn’t had many inquiries related to workplace incidents, but she has had several questions about how to respond to domestic situations that involve threats and violence. In those cases, she can provide referrals to domestic violence shelters and other services. Barrett said the Workforce/Workplace Safety Committee’s work is ongoing. It continues to respond to input it has gotten in surveys of staff about their safety concerns and to review recommendations from groups like the Joint Commission for ways to enhance safety at Our Lady of the Lake. “We’re taking suggestions, we’re taking recommendations and we’re vetting it with evidence-based research,” she said. leisenhauer@chausa.org