Catholic Health World - December 1, 2019

Live from the NICU 3 Providence St. Joseph rebrands 7 Executive changes 7 PERIODICAL RATE PUBLICATION

DECEMBER 1, 2019 VOLUME 35, NUMBER 21

St. Louis hospitals unite in hopes of breaking cycle of violence

Ascension brings more intentionality to building solidarity with the poor

By LISA EISENHAUER

Continued on 4

By JULIE MINDA

Whitney Curtis

ST. LOUIS — One of the young victims Melik Coffey has worked with in recent SSM HEALTH months was shot as he was walking to a bus stop.

The bullet caused internal injuries so severe that the teenager spent weeks at SSM Health Cardinal Glennon Children’s Hospital in St. Louis, where Coffey met him.

Coffey is a licensed clinical social worker and a key player in a new program the teenager enrolled in that is focused on changing the life trajectory for the hundreds of children and young adults from St. Louis and St. Louis County who are shot, stabbed, beaten, brutally bullied or otherwise traumatized every year. So far this year, city police reports alone show 23 homicide victims age 19 or younger.

Tracy Wafford stands next to a memorial for her 3-year-old granddaughter, Kennedi Powell, outside the home in south St. Louis where the child was killed in June in a drive-by shooting. Another bullet injured a 6-year-old neighbor. Kennedi is one of the 23 homicide victims age 19 or younger in the city so far this year.

When a health crisis abates, patients may continue to suffer UPMC Mercy’s Critical Illness Recovery Center cares for ICU patients with persistent mental or physical impairments

pressure at an alarming 220/180. Fearing she had suffered a stroke, they rushed her to UPMC Mercy, where she was diagnosed with a subarachnoid hemorrhage and placed in intensive care.

Fabian claims she has only one vivid memory of her eight-day stay in ICU. “I awoke at one point, saw a crucifix in my room and said, ‘Dear Lord, if this is my time to come be with you, then it’s my time,’” she says. “Other than daily visits with a priest, I have only vague snippets of recollections — my family being around me or a nurse giving me something in an IV.”

By RENEE STOVSKY

Fran Fabian, 71, was admitted to a Pittsburgh-area hospital in August 2018 for routine gallbladder surgery. Following the procedure, she awoke with a horrible headache, and began sweating profusely and vomiting. Medical staff assumed she was just having a bad reaction to drugs and sent her home to sleep off lingering effects when the post-anesthesia care unit closed at night.

The next day, when she was unable to stand or feel her feet, her son called paramedics. They arrived to find her blood

By NANCY FRAZIER O’BRIEN

Hillery Ross-Furse never knows what challenges she will encounter as she begins work each day as a community health worker for Mercy Health Muskegon’s Pathways to a Healthy Pregnancy program.

It might be a mother so Ross-Furse desperate for money that

Why is this work around solidarity with the poor important for Ascension at this time?

We are in an era of transformation of health care and transformation of our organization. As we engage these efforts, it is essential to connect this call to action with Continued on 2

Fran Fabian got help at the Critical Illness Recovery Center at UPMC Mercy hospital in Pittsburgh after a lengthy hospital stay, including eight days in intensive care, left her frustrated, frightened and out of touch with herself.

Lingering brain fog Fabian spent a total of 34 days in the hospital and at a rehab facility, where she coped with weakness in her right leg, a partial face droop, severe speech problems and bowel and bladder issues from prolonged catheterization. When she finally went Continued on 8

Mercy Muskegon reaches deep into community to aid patients Community benefit program embeds community health workers with social service agencies, medical settings

Ascension is strengthening its commitment to address the structural causes of poverty, a significant factor in an individual’s health span and life span. This system-wide effort involves working to understand the needs of the poor, responding to those needs appropriately and ensuring a culture that promotes “communion and relationship with persons who are poor and vulnerable.”

Mary Paul, Ascension vice president of mission integration, leads a practice area with efforts to build soliMary Paul darity with the poor throughout Ascension, a St. Louis-based system of more than 2,600 care sites, including its 150 hospitals.

She spoke to Catholic Health World about that work.

she is selling her breast milk. It might be a woman with a drug dependency disorder whose pregnancy is threatTRINITY ened by her return to jail. It HEALTH might be a pregnant teenager who simply needs help navigating the maze of paperwork necessary for her to get the government assistance for which she and her child are eligible.

The key, Ross-Furse said, is to “understand the true life and nature of the people we are able to reach so that we can move them and motivate them” toward healthier lives for themselves and their babies.

Bonds that last Tressa Crosby, lead community health worker for the program, recalls one of her first patients — a pregnant woman Continued on 3

PeaceHealth, Mercy promote life balance for caregivers SelfCare for HealthCare aims to improve employee engagement, staff retention and patient safety

By KATHLEEN NELSON

Dalton Cheshire and Britney Johnson learn how to interact with a newborn during a Baby 101 class organized by the Health Project, a Mercy Health Muskegon program.

With two youngsters, staffing challenges and the constantly shifting regulations of health care, Heather Wall shares the struggle to find balance in her life with her nursing staff at PeaceHealth Sacred Heart Medical Center at RiverBend in Springfield, Ore. “As a young mother, I’m trying to lead by example,” said Wall, chief nursing officer at RiverBend. “I have 30 more years left in health care. I want to stay here and be the best I can be.”

To help herself and her staff, Wall successfully advocated for implementing SelfCare for HealthCare, a yearlong program Continued on 6

2

CATHOLIC HEALTH WORLD December 1, 2019

Solidarity with the poor

There is great potential for a team that connects with, listens to and learns from persons we serve.

From page 1

Are all Ascension markets hosting medical missions?

Every Ascension ministry market has had a medical mission, and some markets have had more than one. Ascension has committed to continuing the medical missions in all of its markets.

our mission to be in communion with the poor and vulnerable. When you practice something, it becomes part of who you are.

During times of great change, remembering who we are is critical, and in the midst of challenge it offers the energy and inspiration for the work at hand.

How does a health system truly connect with the poor?

We are seeking to bring ourselves to the table — to the community — to slow down, listen, and respond to the needs in partnership with others. The challenge then is to step back and to assure we’re all oriented in the right way — so that while we’re doing our work, we’re making connections.

The body of work of mission integration supports our identity as a ministry of the church expressed in our mission. In this way, we advance throughout Ascension a common vision and commitment to solidarity. Ascension’s new president and chief executive, Joe Impicciche, is very dedicated to advancing this core commitment in all facets of Ascension’s transformational journey.

How do you keep things moving forward?

We want our efforts around solidarity with the poor to be operationally aligned, intentional and relevant in all our communities so we can make the appropriate impact in partnership with our communities.

Can you provide an example of how this approach benefits the poor or improves access to health care?

One example is our Medical Mission at Home initiative, which involves our ministries partnering with their communities to broaden relationships as we provide community members with a variety of medical and social services. Ministries respond to identified community needs by hosting events where clinicians and other associates partner with community agencies to

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What other efforts are a ready fit for increasing solidarity with the poor?

We’re looking at community benefit, the community health needs assessment, the continuing spread of work related to human trafficking and the Dispensary of Hope. (The dispensary distributes medication to uninsured people through 48 outposts in Ascension facilities.) Further, we are engaged in major efforts to design new models of care for the future.

Volunteers from the Ascension Seton ministry administer a vision exam at a Medical Mission at Home event in Hutto, Texas.

provide access to clinical and social services including basic necessities like food.

What impact is this work having on Ascension’s culture?

These medical missions and the like help us remember who we are as an organization as they also energize our individual vocations as healers, reconnecting us to our passion for service.

Solidarity with the poor is important to Ascension because it’s central to who we are. Being focused on our commitment to solidarity urges us to expand our thinking and also to recognize and reflect on our own poverty.

What assistance did Ascension offer in markets that were new to Medical Mission at Home?

Each ministry identified operational executives to lead or sponsor the medical mission events. We had collaborative sessions with the ministry leaders and associates to share ideas and opportunities and bring different disciplines together to address questions around the impact we wanted to have.

We provided planning materials and utilized the community health needs assessment to identify and focus on specific needs, in collaboration with various clinical providers, social service agencies and others. After the medical missions, our par-

ticipants reflected on the experience and implemented at least one learning into routine operations.

Why the focus on the practice of reflection?

Guided reflection provides the opportunity to see the meaning for those we serve and for ourselves in serving, and also to consider ways to improve our connection with community. It is a way to listen, learn and respond. This offers learning from the populations that are most vulnerable.

How does solidarity with the poor sharpen community benefit work?

We’re asking: “What is the impact we’re having in our communities and how can we increase that impact?” The goal isn’t just to account for community benefit work, but more importantly to ask what changes we are trying to effect and how to measure our impact. We want to strengthen our connections in service to community.

In all of this work we are growing the ways in which we serve, and deepening the culture of encounter, the way to be with persons in need as we respond to their needs.

INTERNATIONAL HUMAN SOLIDARITY DAY Dec. 20

Spirit of God, you are the source and fount of all creation.

As you are one, make us one. Unify us in an awareness, which sees the plight of your children around the world. Unify us in a hope, which speaks of a better future. Unify us in a justice, which works for the world you dream.

Unify us in a love, which prioritizes relationships of care. Unify us in a joy, which witnesses to your eternal goodness. Unify us as one human family, with a shared home and common destiny in you. Unify us now to act on behalf of the marginalized, voiceless and unseen.

As you are one, make us one. Amen.

For more prayers visit chausa.org/prayers

Upcoming Events from The Catholic Health Association Faith Community Nurse Networking Call Dec. 10 | 3 p.m. ET

Human Trafficking Networking Call Dec. 12 | Noon ET

2020 International Outreach Networking Call Feb. 5 | 3:30 p.m. ET

Critical Conversations 2020 Feb. 12 – 13 Atlanta (Invitation only)

Diversity and Disparities Networking Call

Ecclesiology and Spiritual Renewal Program for Health Care Leaders April 26 – May 1 Rome and Assisi, Italy (Invitation only)

Feb. 19 | 1 – 2 p.m. ET

International Outreach Networking Call

Sponsor Formation Program for Catholic Health Care

2020 Catholic Health Assembly

Session Two: March 26 – 28 (Invitation only)

April 29 | 3:30 p.m. ET

June 7 – 9 | Atlanta

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

December 1, 2019 CATHOLIC HEALTH WORLD

3

Cameras in Covenant NICU let loved ones see babies anytime

By JULIE MINDA

To ease parents’ anxiety when they cannot be physically with their infant in the neonatal intensive PROVIDENCE care unit, Covenant ST. JOSEPH Children’s hospital in HEALTH Lubbock, Texas, has installed video cameras at each of the hospital’s 43 NICU incubators.

The facility switched on the highdefinition NicView brand cameras in March.

Each camera is focused on the occu-

pant of a single incubator and transmits continuous livestream video. The cameras have a “night vision” functionality for recording in low light.

Covenant provides new parents with a secure access code they can use to view their babies anytime, from any device that is equipped to access the Internet. Parents can share their access code with loved ones.

The babies’ nurses also can access the livestream.

Tiffany Patterson, Covenant Children’s NICU nurse educator, said the hospital’s “family-centered care committee” came

Video cameras installed over incubators in the neonatal intensive care unit at Covenant Children’s hospital transmit images that can be viewed at anytime by family members and clinicians. The camera lens is in the square apparatus atop the lightbox.

A clinician at Covenant Children’s hospital in Lubbock, Texas, views an infant on a livestream video from the neonatal intensive care unit.

Health Project From page 1

abusing drugs who lost her child to miscarriage. “But she knew she could call me if she ever needed anything,” and when the woman became pregnant again, she called to say, “I want to do this right; I want to keep this baby,” Crosby said.

Through Pathways to Crosby a Healthy Pregnancy, the woman was able to enter a drug treatment program, get the medication and other assistance she needed and give birth to a healthy baby girl.

“Those are the types of connections we are able to make,” Crosby said. “When things go wrong, they still have the trust and confidence in us to say, ‘This is what is going on with my life.’”

The expectant and new mothers “are very grateful to have someone they can call and talk to,” said Crosby. “I have patients from three years ago that will email me.

They’re thankful that I am always there to help with lots of emotional support.”

Pathways to a Healthy Pregnancy is just one program that makes up the Health Project, the community benefit ministry of Mercy Health Muskegon in Michigan, part of Trinity Health. Since it came under the Mercy Health Muskegon umbrella in 2009, the Health Project has responded in a multitude of ways to problems uncovered through Mercy Health Muskegon’s community health needs assessment process.

Its services include the Mercy Health Physician Partners food truck; the Wheels of Mercy mobile health van; Lungs at Work, an in-school anti-smoking program for preschoolers through high schoolers; KnowSmoke, which educates the community about the dangers of vaping; Eyes of Hope, a mobile vision care clinic; Muskegon Prescribes Food for Health, a 12-week program that teaches participants how to cook healthy meals; the Pharmaceutical Access Program; and Pathways to Re-Entry, which helps recent parolees connect to a medical home and social services.

Hub and spokes The Health Project operates through a “hub” that serves as a clearinghouse matching patients with the community agencies and health workers most suited to their needs.

“We serve as a traffic cop for all the referrals that come in and deploy community health workers based on their expertise,” said Judy Kell, hub operations manager, who has been associated with the Health Project as an employee or contractor Kell for the past 15 years.

Community health workers are embedded with a variety of community agencies — homeless shelters, ob-gyn practices, a domestic violence shelter, emergency rooms, senior high-rise communities, infectious disease clinics and other sites.

The Health Project also has formed and works with a number of community coalitions addressing specific social influences on health, such as tobacco use and substance abuse.

Kell has seen a shift in community health priorities since she started. “One thing that has been very successful is that when the drug-free coalition started, binge drinking was very high in our community,” she said.

“But that has changed over time as we get more and more prevention work.”

The project also has seen “some very significant changes” in use of emergency rooms by patients with chronic diseases when they have received assistance in meeting other needs, such as housing, transportation to medical visits with their primary care physicians and consistent use of medications, she added.

Measures of success A study by Grand Valley State University showed the effects of the Pathways to a Healthy Pregnancy program in terms of dollars and cents. With program costs ranging from about $300 to $390 per patient, the study found that $2,431 in medical costs was avoided for each mother with delivery of a healthy birth-weight baby.

Patients enter the program “at high risk in terms of social needs and medical needs,” including high blood pressure, cancer, obesity, domestic violence, homelessness and poverty, Crosby said. The study found, however, that “for patients enrolled in their first (or early second) trimester, birth outcomes exceeded their Medicaid peers and were brought to the same level as that of commercial insurance patients.”

Reaching vulnerable seniors The project’s Senior Transitions program showed even greater success in return on investment. Assisted by a brief ques-

up with the idea to use the cameras, and Covenant’s charitable foundation, community donors and employees paid for the equipment.

The NicView camera is manufactured

by Natus Medical Inc. of Pleasanton, Calif.

According to Kristina Malloy, director of

tionnaire that measured risk through an evidence-based algorithm, community health workers provided education and care coordination to seniors leaving hospitals and nursing homes.

With a cost of $246,732, the program saved more than $1 million in the patients’ first 30 days after discharge, with a median participant savings of more than $18,500.

“We are also seeing more and more need for services” for seniors, Kell said. Through the project’s Senior Navigator program, community health workers go to sites frequented by seniors to help link them to other needed services, she added.

Flexible format The most recent community assessment identified child care availability and afford-

downstream marketing for Natus, NicView cameras went on the market in 2010. More than 300 U.S. hospitals and more than 25 facilities overseas use the technology.

She said the vast majority of Natus customers use their NicView cameras in the NICU, but some use them in labor and delivery, for instance, to enable a parent deployed in the military to witness the birth of a child. And, some facilities use the cameras in pediatric intensive care units, said Malloy.

Covenant is among a growing number of facilities installing such cameras to better support parents who must leave the hospital so that they can rest, tend to other children at home, go back to work or see to other obligations. Loved ones who might have a virus can turn on the video feed to safely “visit” the medically fragile newborn.

Patterson said moms who have had to express breast milk for their babies from outside the NICU have found “they are having better success with pumping and milk production” when they can see their babies on the livestream while expressing. “There have been reports that moms who are able to pump near their baby or even looking at a picture of their baby will have better production, so these moms being able to watch a live feed from wherever they are can be very impactful.”

ability, substance abuse, the cost and availability of nutritious foods, education and employment issues, sexually transmitted diseases and advance directives as the top concerns influencing health in the Muskegon area.

“One of the beauties of the pathways program is it is not limited” to one or two types of assistance, Kell said. “We also assist people in returning to school and in connecting with our Michigan Works!

Association,” which provides support and services for the state’s workforce development system.

“It’s a nice approach in terms of being able to address any of the issues a patient might have in terms of social determinants” of health, she added.

Catholic systems acquire hospitals from Community Health Systems Over the past three years, Community Health Systems of Franklin, Tenn., has been completing what it calls a “portfolio rationalization and deleveraging strategy.”

The publicly traded hospital company has shed more than 80 hospitals since 2016, according to a HealthLeaders Media analysis. Currently, Community Health has 102 affiliated hospitals in 18 states. The system has a total of about 17,000 beds.

This year, two ministry systems, Bon Secours Mercy Health and CommonSpirit Health, have been among those acquiring the divested facilities.

Virginia Bon Secours Mercy Health announced its intent to purchase three hospitals in southeastern Virginia from Community Health. The hospitals would become part of the Bon Secours Mercy Health Atlantic Group and would become Catholic hospitals, according to Bon Secours Mercy Health.

The hospitals are: The 300-bed Southside Regional Medical Center in Petersburg, which has three professional schools on campus and seven satellite outpatient centers.

The 105-bed Southampton Memorial Hospital in Franklin.

The 80-bed Southern Virginia Regional Medical Center in Emporia.

Bon Secours Mercy said in an Oct. 28

media release that it has an asset purchase agreement in place and is working toward a definitive agreement. It expects the sale to be finalized by the end of the year.

John Starcher, president and chief executive of the 43-hospital Bon Secours Mercy Health, said in the release that the system will continue to invest in the health and well-being of residents of southeastern Virginia. Bon Secours Mercy has nine hospitals in Virginia.

Texas In August, CHI St. Joseph Health of Bryan, Texas, acquired the 167-bed College Station Medical Center of College Station, Texas, from Community Health. CHI St. Joseph is part of the 142-hospital CommonSpirit Health.

The medical center was renamed CHI St. Joseph Health — College Station Hospital and it now is operated as a Catholic nonprofit facility. Its physician clinics also have adopted the CHI St. Joseph Health moniker.

With the acquisition, CHI St. Joseph has five hospitals in the region and more than 50 clinics and other outpatient sites.

The College Station hospital, which is a Level III Trauma Center, is within 10 miles of CHI St. Joseph’s flagship facility, CHI St. Joseph Health Regional Hospital of Bryan. That 236-bed regional hospital is a Level II Trauma Center.

4

CATHOLIC HEALTH WORLD December 1, 2019

Whitney Curtis

by LOV social workers, the victims have suffered near-fatal gunshot wounds. But in some cases, the assault victims have no visible marks. As long as the victim is hurt in a non-domestic incident, has sought care in one of the hospitals’ ERs and meets the program’s residency requirement, that person is eligible to enroll in LOV. The social workers meet with their clients for six months to a year, until the young person is in a stable place both physically and mentally. The goal is to keep the victims from being caught in a cycle of violence and retaliation claiming more, and often repeat victims.

Chante Bass watches her children and grandchildren play as she holds her 10-month-old grandson Lamarco Sharp Jr. The family lives in north St. Louis, which has long been plagued by gun violence.

Breaking violence cycle

ing from the Missouri Foundation for Health to cover the salaries of Coffey and four other social workers who offer case management, therapy, counseling and mentoring services for any victim of gunshot, stabbing or assault age 8-24 who comes into the hospitals’ emergency rooms for care and lives in St. Louis city or county. In the city of St. Louis alone, the police department logged 698 incidents of aggravated assault with 1,080 victims age 24 or younger from January through September of this year.

In the most serious cases undertaken

About these photos The news photographs that accompany this story were taken by St. Louis-based freelance photographer Whitney Curtis to illustrate a news report on the fatal shootings of black children in St. Louis that was published by The Guardian in October. At the time The Guardian’s report was published, 13 black children age 16 or younger had been fatally shot in the city since the beginning of the year.

From page 1

The program Coffey is part of, called Life Outside of Violence, is a collaboration of the four hospitals in St. Louis with Level 1 trauma designation: SSM Health Saint Louis University Hospital and the system’s adjacent Cardinal GlenCoffey non Children’s Hospital, and BJC HealthCare’s Barnes–Jewish Hospital and neighboring St. Louis Children’s Hospital. The BJC and SSM Health nonprofit academic medical centers are located within about a 2-mile radius. All four have treated an increased number of

young victims of violence in recent years.

In the case of the teenager shot at the bus stop, Coffey helped him meet his goal of returning to work and linked him with tutoring so he could catch up in school and graduate with his class.

The LOV program is using grant fund-

Firearm injuries St. Louis city Age of victims Under 15

2012

2013

2014

2015

2016

2017

7

8

9

12

11

13

15-24

164 152 175 167 146 123

All ages

328

377

397

Percent of total victims 52% 52% 52% 48% 42% age 24 and under

307

355

374

34%

St. Louis County* Age of victims Under 15 15-24 All ages

2012

2013

2014

2015

2016

2017

5

1

7

10

5

15

95 115 128 192 139 128 211

219

265

372

297

321

Percent of total victims 47% 53% 51% 54% 48% 45% age 24 and under *St. Louis city is not part of St. Louis County Source: Missouri Department of Health & Senior Services

Measuring impact of intervention What sets LOV apart from the other violence intervention programs, those overseeing it say, is the coordination between the four hospitals. (LOV is formally called the St. Louis Area Hospital-Based Violence Intervention Program.) They are sharing patient information and related data to determine if the interventions

Treating victims of violence takes emotional toll on caregivers, propels anti-violence efforts E

Whitney Curtis

A memorial of toys, flowers and photos sits outside the north St. Louis house where 7-year-old Xavier Usanga was killed by gunfire in August. The shooting happened the day before he was to start second grade. A suspect in the shooting has told police that his target was someone else, according to local media reports. The shattered window in this picture is unrelated to the shooting of Xavier.

Chronic trauma Kateri Chapman-Kramer, LOV’s project coordinator, says the anti-violence program, which started in August 2018, is modeled on a program that had been underway at St. Louis Children’s Hospital since 2012.

Similar programs elsewhere in the nation have Chapman-Kramer existed since the 1990s.

Many were started in the wake of a study called “Urban Trauma: A Chronic Recurrent Disease,” published in the July 1989 Journal of Trauma: Injury, Infection and Critical Care. Researchers found that of the 501 survivors of violent trauma treated at one trauma center over a two-year period, 20 percent were dead and 44 percent returned with a violent injury within five years.

ven for a city that regularly ranks high on crime lists, 2019 has been a bad year in St. Louis, especially for its young residents.

Through Sept. 30, the number of people killed in the city whose deaths were recorded as homicides was 156. Of those homicides, 56 were age 24 or younger.

SSM Health Cardinal Glennon Children’s Hospital lost six young patients to gunfire by mid-September.

Dr. Colleen Fitzpatrick, Fitzpatrick the former medical director of the hospital’s trauma program, said the hospital had treated at least 50 gunshot victims in that period, “as many and often significantly in excess of what we’d typically see in a year.”

Some of the children were as young as 3. Some were victims of random violence.

Others accidentally shot themselves with guns left unguarded in their homes.

Fitzpatrick is a strong supporter of Cardinal Glennon’s efforts to stem the violence epidemic, including partnering in the Life Outside of Violence project and handing out gunlocks in its emergency room.

“I think at this point anything we can do to curb gun violence, it needs to be done,” she says.

Joshua Dugal, trauma program manager at Cardinal Glennon, says, in addition to more victims, the hospital is seeing a troubling new reality: wounds from assault weapons. “It had Dugal been for the past several years lots of handguns, and handguns are horrible, and you can certainly die from a handgun injury, but we’ve had several chil-

dren this year injured by assault rifles and those are weapons of war,” Dugal says.

He is collecting data that will be combined with information from other hospitals and used to track LOV enrollees’ outcomes. “This is truly data sharing that is going to be impactful,” he says.

At SSM Health Saint Louis University Hospital, the number of violence victims is also up sharply for the year. As of Sept. 20, the hospital had treated 263 gunshot victims, putting it on track for about a 20 percent increase over the previous year.

Cathy A. DuPont, administrative director of nursing for the hospital’s emergency departDuPont ment, says she believes the violence is rooted in socioeconomic issues in the St. Louis region, where a 2014 study called “For the Sake of All” found the average life span between ZIP codes can vary as much as 18 years and census figures released in 2018 showed 25 percent of St. Louis city residents live in poverty, compared to 9.8 percent of St. Louis County residents and 14.6 percent of people nationwide. The city of St. Louis is not part of St. Louis County.

In addition to shattering young lives and those of victims’ families and peers, the violence takes an emotional toll on caregivers. Seeing so much bloodshed in SLU hospital’s ER “wears on the team,” which is made of up many parents of young children, DuPont says.

Like Fitzpatrick and Dugal, she is hopeful that the LOV program will succeed and that she and other ER workers won’t see its enrollees again. “I think it would be uplifting to the team to be able to see people rise up and above and out of that situation,” she says.

— LISA EISENHAUER

December 1, 2019 CATHOLIC HEALTH WORLD

5

Rethinking choices Stephanie Harris, a social worker who is part of LOV, says the project Harris tries to redirect young violence victims who might consider their only or best response to be striking back.

“It helps people see their options so they can make the right choices,” says Harris, who is based at SLU hospital.

Most of the violence victims referred to Harris are black or Hispanic young men in their late teens or early 20s who were shot.

They include a young man who was in a shootout and others who were bystanders when gunfire broke out.

She and the other social workers use a variety of therapeutic techniques to help clients, including: Trauma-informed counseling where clients talk about issues around their injuries and work through their feelings and emotions.

Dialectical behavior therapy, a type of cognitive therapy with the goal of helping a client gain better control of emotions, cope with stress and improve

Whitney Curtis

work to prevent revictimization. “For the hospitals that are a part of this partnership, it was very clear they were often seeing the same patients come in for repeat injuries and so it made sense to join efforts to address this,” Chapman-Kramer says.

In addition to the four hospitals, Washington University in St. Louis, Saint Louis University and the University of Missouri– St. Louis are partners in the project. They will conduct related research and evaluation, such as tracking the patients’ long-term outcomes.

Pleas for an end to violence are on the wall of an abandoned corner store and a sign out front in north St. Louis. Workers at SSM Health Saint Louis University Hospital and SSM Health Cardinal Glennon Children’s Hospital say both hospitals are seeing more young violence victims this year than in recent years.

relationships.

Motivational interviewing to encourage a client to undertake specific tasks such as to stop smoking marijuana or get a job.

Crisis intervention to address specific critical situations, such as to help a client work through a conflict that could lead to homicidal or suicidal thoughts or to help them get immediate assistance, such as to prevent impending homelessness.

The social workers approach the victims or their parents in the ERs if possible, but, in the case of victims who need hos-

pitalization, they wait until an appropriate time in their recovery. A LOV counselor may meet with some clients multiple times a week and others as infrequently as every few weeks. The meetings depend on the level of therapy and case management needed by the individual clients.

Harris sits down with her LOV clients to find out what their immediate needs are.

Clients might need help navigating the health care system to access medical care as they recuperate, or the legal system as they move to clear up past run-ins with

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Leadership

CHA Ministry Identity Assessment

CHA Ministry Identity Assessment

SCORING: 1 (POOR) 2 (FAIR) 3 (GOOD) 4 (VERY GOOD) 5 (EXCELLENT)

CHA MINISTRY IDENTITY ASSESSMENT

ARCHBISHOP J. AUGUSTINE DI NOIA

Adjunct Secretary Congregation for the Doctrine of the Faith

“I have reviewed the CHA Ministry Identity Assessment and the results gathered from the four pilot sites.

I am impressed by the level of honesty and transparency the key performance indicators require. Looking at the daily operations and decisions of the health ministry from the lens of CHA’s core commitments will make the mission

and values of Catholic health more relevant for all involved in the process.

Finally, seeing ministry identity as part of an organization’s continuous quality improvement is an excellent way to assure accountability and fidelity to the mission of the church. I heartily endorse the CHA Ministry Identity Assessment.”

TO LEARN MORE, VISIT

chausa.org/CHAMinistryIdentityAssessment

*Please note: the tool is available only to CHA representative members.

the law. Some individuals are food insecure, others want to move to a different neighborhood, one where they can get a fresh break.

Harris says apart from accessing outpatient medical care, employment is “the number one goal for most people and that’s often the reason they might enroll into the program.” She links her LOV clients to job training and placement programs such as Job Corps and offers referrals to hiring managers.

Better lives Beyond their basic needs, Harris helps her clients set goals to reach personal milestones meant to change the course of their lives. “I’ll try to work with them for something for them as a person, something they can take with them wherever they go,” she says. That could include working on having more patience or improving their interpersonal skills.

From the program’s start through September 2019, social workers had invited about 600 young violence victims treated at one of the four trauma center hospitals to join the program. Of those approached, 109 enrolled.

Coffey is based at Cardinal Glennon, so his LOV clients tend to be teenagers, his youngest was only 10.

Often the violence experienced by his clients is related to bullying at school. His mission in those cases is to help victims develop skills to cope without lashing out.

“If I can apply some therapeutic interventions immediately, then you have a greater chance that you won’t incur the symptoms of (post-traumatic stress disorder) or heightened anxiety or depression,” Coffey says.

One of Coffey’s clients joined the program late last year after school bullying turned violent. The adolescent boy was already skipping school because of the bullying and didn’t want to return after the violent incident. Coffey helped the boy cope with the trauma of the assault, learn to manage his anger and de-escalate situations when he was being antagonized so he could avoid reinjury.

Coffey says the boy was back in school within months. “He was able to get his grades up, so much so that he ended up getting on the honor roll for the last two quarters of that school year and he was also given an award for excellence in mathematics,” Coffey says.

Through its first year, the LOV program had the kind of success its founders were hoping for. None of the enrollees wound up back in any of the ERs. But then in September, as Harris was about to wrap up a case, a client told her that he’d been shot a second time. The young man agreed to extend his time in LOV. leisenhauer@chausa.org

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CATHOLIC HEALTH WORLD December 1, 2019

Work/life balance

Key features of SelfCare for HealthCare A two-day orientation led by LeAnn

From page 1

designed to restore balance in the lives of caregivers.

Founded by LeAnn Thieman, a nurse whose practice spanned three decades, the program has been used at 24 hospitals or health systems nationwide. It has shown promising results, including as a pilot program for the nursing staff at PeaceHealth RiverBend and at Mercy Medical Center in Cedar Rapids, Iowa, where it is offered to every employee.

“We really believe that everyone is a caregiver and believe in taking care of all staff,” said Molly McWilliam, wellness coordinator at Mercy Cedar Rapids.

Taking care of the caregivers The altruistic nature of a health care worker can be his or her undoing, especially when faced with long hours, staff reductions and ever-shifting regulations, policies and procedures.

“They sacrifice themselves to care for

LeAnn Thieman, founder of SelfCare for HealthCare, and Mary Brobst, chief nursing officer at Mercy Medical Center in Cedar Rapids, Iowa, celebrate the success of the program. Mercy Medical has enrolled about 1,000 of its 3,000 employees in SelfCare since the program’s 2016 launch there.

others,” said Thieman, who has written or co-written 16 books, 13 of them in the “Chicken Soup for the Soul” series. “That’s how we get derailed. Our loving hearts allow us to shortchange ourselves.”

Health care workers, nurses in particular, empty the tank on the job, losing balance in their lives and their love for the calling. A survey of research published in 2015 by Marshall University of Huntington, W.Va., noted that burnout rates reported among nurses in those studies ranged from 30 to 70 percent.

A study published in July of this year in the Journal of the American Geriatrics Society reported that 30 percent of registered nurses in long-term care facilities exhibited high levels of burnout, 31 percent were dissatisfied with their job and 72 percent reported missing one or more necessary care tasks on their last shift due to lack of time or resources.

Thieman added that the risk of burnout also is high among home health workers, “who work on islands, without the companionship and support of colleagues.”

Burnout drives staff turnover. Thieman noted that the average hospital loses $5 million to $8 million a year due to RN turnover, making staff retention a high priority for cost containment.

“Caring for the caregiver is the best way to improve health care,” Thieman said.

Working with chief executives, chief nursing officers, human resources directors and experts on how adults learn, she developed a yearlong program with the goal of changing behaviors and cultures to improve employee satisfaction that would in turn improve patient safety and staff retention.

Wall, one of the CHA Tomorrow’s Leaders class of 2019, was sold on the program because of its holistic, research-based approach. “When I saw the outcomes, it surpasses everything else,” she said. Those outcomes, reported by Thieman from other hospitals in her program, include: 13 percent improvement in retention

From left, Dawn Holdt, Heather Wall and Joanna Long of PeaceHealth Sacred Heart Medical Center at RiverBend take part in an August 2018 presentation of a nursing award. Holdt was then program coordinator for nursing administration and is now senior quality facilitator; Wall is chief nursing officer; and Long is a nurse in the surgical unit.

from one year to the next.

21 percent increase in work engagement.

16 percent decrease in sick days, saving thousands of dollars.

RiverBend committed to the program for two years, initially offering it in the spring to nurses, certified nursing assistants, recreational therapists and pharmacy staff.

“Over the past 10 years or so, there’s been so much leadership turnover at the executive level. I wanted to give them something that was a stabilizing force,” Wall said, adding that all RiverBend staff will be eligible to participate next year. If results are promising, the program will be offered throughout

PeaceHealth, she said.

Since Mercy joined the program in 2016, more than 1,000 of its 3,000 staff members have participated. McWilliam reported that 63 percent of participants who responded to a survey midway through the program’s third year agreed with the statement, “I am balancing my life mentally (e.g., breathing, relaxation, positive thinking, laughter, forgiveness).” This represents a 43 percent increase from the survey at the beginning of the first year. The respondents reported a 45 percent increase over the same time in balancing their spiritual life and a 38 percent decrease in considering leaving their positions.

Thieman, creator of SelfCare for Healthcare. She meets with leadership and tours to meet staff and thank them for all they do.

A study guide with 12 chapters, one for each month.

A monthly video to introduce each chapter, which deals with such topics as relaxation, positive thinking, forgiveness, connecting with a higher power, time management and decision-making.

A weekly Monday motivation email from Thieman. “I get more feedback on those than any other aspect of the program,” said Molly McWilliam, wellness coordinator at Mercy Medical Center of Cedar Rapids, Iowa. “They’re short, upbeat and end with an inspiring quote.

People say they love it.”

A unit champion, who leads activities that all participants can engage in together monthly.

A mobile app. Working with the American Nurses Association, Thieman secured continuing education credit of 26 contact hours for nurses who participate for an entire year and log the hours through the app. McWilliam said about 100 caregivers at Mercy use the app.

“We can’t ‘unbreak’ the system, but we also cannot give from an empty well,” Thieman said. “When we are strong of mind, body and spirit, we can deliver the care our patients deserve and carry on our healing ministry of Jesus Christ.”

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December 1, 2019 CATHOLIC HEALTH WORLD

Dozens of ministry hospitals earn Practice Greenhealth honors Nearly three dozen Catholic health facilities were among the 390 U.S. health care organizations to receive recognition this year for their environmentalism, through Practice Greenhealth’s 2019 Environmental Excellence Awards program.

The nonprofit membership organization awarded the honors during its CleanMed conference in Nashville, Tenn., in May. CleanMed is Practice GreenHealth’s national conference for leaders in health care sustainability.

CHA members recognized with awards included:

Greenhealth Emerald Award For facilities receiving exemplary scores in a range of categories that Practice Greenhealth uses to evaluate facilities’ progress: Dignity Health – California Hospital Medical Center, Los Angeles (Dignity Health is part of CommonSpirit Health.)

Providence St. Joseph Health – Providence St. Patrick Hospital, Missoula, Mont.

Partner for Change Award For facilities that achieve superior performance in sustainability and make substantive progress eliminating the use of mercury: Ascension – St. Vincent Indianapolis

Hospital, Indianapolis Bon Secours Mercy Health – Our Lady of Bellefonte Hospital, Ashland, Ky. Dignity Health – Arroyo Grande Community Hospital, Arroyo Grande, Calif.

Dignity Health – Dominican Hospital, Santa Cruz, Calif.

Dignity Health – Marian Regional Medical Center, Santa Maria, Calif.

Dignity Health – Mercy General Hospital, Sacramento, Calif.

Dignity Health – Methodist Hospital of Sacramento Dignity Health – Northridge Hospital Medical Center, Northridge, Calif.

Dignity Health – Sierra Nevada Memorial Hospital, Grass Valley, Calif.

Dignity Health – St. John’s Pleasant Valley Hospital, Camarillo, Calif.

Dignity Health – St. John’s Regional Medical Center, Oxnard, Calif.

Dignity Health – St. Joseph’s Medical Center, Stockton, Calif.

Hospital Sisters Health System – HSHS Sacred Heart Hospital, Eau Claire, Wis. Hospital Sisters Health System – HSHS St. Elizabeth’s Hospital, O’Fallon, Ill. Hospital Sisters Health System – HSHS St. Clare Memorial Hospital, Oconto Falls, Wis. Hospital Sisters Health System – HSHS St. Francis Hospital, Litchfield, Ill.

Hospital Sisters Health System – HSHS St. John’s Hospital, Springfield, Ill. Hospital Sisters Health System – HSHS St. Joseph’s Hospital, Chippewa Falls, Wis. Hospital Sisters Health System – HSHS St. Mary’s Hospital Medical Center of Green Bay, Wis. Hospital Sisters Health System – HSHS St. Nicholas Hospital, Sheboygan, Wis. Hospital Sisters Health System – HSHS St. Vincent Hospital, Green Bay, Wis. Providence St. Joseph Health – Providence Centralia Hospital, Centralia, Wash.

Providence St. Joseph Health – Providence Holy Family Hospital, Spokane, Wash.

Providence St. Joseph Health – Providence Newberg Medical Center, Newberg, Ore. Providence St. Joseph Health – Providence St. Peter Hospital, Olympia, Wash.

St. Cloud Hospital, St. Cloud, Minn.

TriHealth Good Samaritan Hospital, Cincinnati For a more extensive list of awards received, visit chausa.org/chworld.

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EXECUTIVE REFERRAL PRESIDENT/CEO Michael J. McBride to regional president and chief operating officer for Ascension St. John in Oklahoma, from president and chief executive of Franciscan Missionaries of Our Lady Health System, Baton Rouge, La.

ADMINISTRATIVE CHANGE John Tersigni to chief mission integration officer of Ascension Insurance, which provides Ascension members and employers with financial protection products.

OBITUARIES Daniel F. Russell died Nov. 13. He was 79.

He was a past president of Catholic Health East of Newtown Square, Pa., which merged with Trinity Health of Livonia, Mich., in 2013.

He was instrumental in the formation of Global Health Ministry, a medical mission organization that was part of CHE and that is now part of Trinity.

Sr. Mary Damian “Grace” Waldron, RSM, died Nov. 6 at age 101. She was one of the sisters who assumed management of Holy Cross Hospital in Fort Lauderdale, Fla., in 1959. The hospital had opened in 1955.

The facility now is part of Trinity Health of Livonia, Mich.

GRANT The Ronald McDonald Children’s Hospital of Loyola University Medical Center has received a $1 million gift from the estate of Jerome Taplin. According to a press release, the funds will enhance the medical and support services that the Maywood, Ill., facility provides to hospitalized children.

The 100-bed children’s hospital-within-ahospital includes a neonatal intensive care unit, pediatric intensive care unit and general pediatric beds, along with a family room and a children’s playroom.

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Providence St. Joseph Health is rebranding itself as Providence starting next year.

The new brand will use the St. Joseph Health cross in the logo.

The health system based in Renton, Wash., said the name change will start rolling out in June at its operations in Southern California. The complete transition

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for the 51-hospital system could take up to three years elsewhere in California and at its operations in Alaska, Montana, New Mexico, Oregon, Texas and Washington state.

The two nonprofit Catholic systems — Providence Health & Services and St. Joseph Health — came together in 2016.

The new brand “reflects the heritages and Catholic identity of both organizations while making it easier for patients, families and consumers to identify the comprehensive network of care offered by the combined health system,” Providence St. Joseph Health said in a press release.

The new brand will appear with the legacy name of each hospital on buildings and signage. The name change will not affect the leadership or staffing within the ministries, the system said.

The non-Catholic partners that are part of the current Providence St. Joseph Health network, such as Swedish Health Services in Seattle, will retain their current brands.

8

CATHOLIC HEALTH WORLD December 1, 2019

Recovering from the ICU home, Fabian says she began to feel like she had been “abducted by aliens.” “I was not myself anymore, and I certainly didn’t recognize my life. I wasn’t functioning like I did before, and I was frustrated and frightened.”

Her symptoms included an inability to concentrate or stay on task, as well as anxiety and depression. “If my brain wasn’t scrambled before I went to the hospital, it certainly was when I came out. I felt like I was losing my mind, and I worried that this might be the beginnings of dementia,” she says.

Lucky for Fabian, UPMC Mercy had just launched its Critical Illness Recovery Center in May 2018 under the direction of Dr. Brad Butcher, co-director of the medical and surgical intensive care unit there, and Tammy Eaton, a nurse practitioner who has spent most of her career in critical and palliative care.

The center’s goal is to address in a multidisciplinary, holistic way the problems associated with what is now recognized as post-intensive care syndrome. An array of providers — from intensivists and critical care specialists to occupational, physical and respiratory therapists as well as dietitians, social workers, pharmacists and speech/language pathologists — work together at the center to tailor a program specific to each patient’s needs and goals.

Fabian says the program is helping her cope with problems she experiences after being in the ICU for stroke care.

Connie Bovier, center, and her daughter, Celeste Lapen, left, take part in a peer support program for former ICU patients and family members at UPMC Mercy in Pittsburgh. Bovier spent 22 days in the intensive care unit in 2018. Maria Shoemaker, right, is an occupational therapist in the hospital’s Critical Illness Recovery Center.

We reconciliate medications, give immunizations, discuss meal plans, do swallow assessments, give prescriptions for various therapies — whatever is appropriate. Then we forward our entire report to the patient’s primary physician,” she says. “We also have family members complete questionnaires about caregiver burden, provide counseling and give them strategies to cope with stress.”

Adds Butcher: “We recap patients’ ICU experience for them and discuss their quality of life and future goals. People experiencing (post-intensive care syndrome) can be a challenging population; many are weak, depressed and have cognitive difficulties. Some are self-motivated to improve their outcomes, but many need a cheerleader. We focus on body, mind and soul.”

After the initial screening, patients return for two-hour visits every three months for as long as it takes to manage their recovery process. “Our goal is to support the patient and family in adapting to a new normal after critical illness,” says Eaton.

ABC’s of ICU care Butcher recalls that when he was training in critical care medicine, the staff would rejoice when patients left the ICU. “The thinking was, ‘High five, they’re alive!,’” he says. “It’s only been in the last 10 years that we have begun to ask ourselves what kind of life those patients Peer and family are returning to.” support group Part of the Soci- Tammy Eaton, a nurse practitioner, and Dr. Brad In January Merety of Critical Care Butcher are the co-founders of UPMC Mercy’s cy’s Critical Illness Medicine’s proactive Critical Illness Recovery Center. The center takes Recovery Center response to mitigat- a holistic approach to treating post-intensive care began a monthly peer support proing post-intensive syndrome. care syndrome sympgram for patients toms (see sidebar) has been to recommend and family members. “It’s a venue to discuss a critical care “ABCDEF Liberation Bundle,” common experiences so patients realize which is now used in many hospital ICUs they are not on this journey alone,” Eaton nationwide. “A” is for assessing, preventing says. Held in a private conference room and and managing pain; “B” is for both sponta- moderated by Butcher and Eaton, the twoneous awakening and spontaneous breath- hour program begins with a presentation ing trials to reduce the length of time on led by a specialist and is followed by group ventilator-assisted breathing machines; “C” discussion. Recent topics have included is for choice of analgesia and sedation; “D” compensating for memory loss, home is for delirium assessment, prevention and safety and energy conservation, nutritional management; “E” is for early mobility and exercise; and “F” is for family engagement and empowerment.

“It’s a way to emphasize things we can do in ICUs to reduce long-term consequences for patients,” says Eaton. “Since many people describe their stays as ‘dreamlike,’ with he recognition of post-intensive care no sense of time or reality, we also try to syndrome is relatively recent, and provide as much natural light as possible treatment methods are still evolving, during the day, turn off lights at night, open according to Dr. Mark Mikkelsen of the up visiting hours and allow family members Society of Critical Care Medicine. Mikto be part of doctors’ rounds.” kelsen co-chaired a task force dedicated

support and faith-based healing.

“This program is near and dear to my heart; its mission aligns so beautifully with Mercy’s core values of dignity and respect,

to funding support groups for ICU patients and their families nationwide.

“The origins of intensive care units can be traced to the polio epidemic of the 1950s, when ventilatory life support was first developed,” he says. “Today there are 5 to 6 million patients in the United States who spend time in an ICU each year. And as mortality rates have improved, there has been a growing recognition that survivors can experience persistent impairments in functional domains of mental and physical health.”

In fact, it wasn’t until 2010, says Mik-

Uphill slog She was one of the first patients to complete a year in the Critical Illness Recovery program.

Nowadays, she says she is still adjusting to her new reality and is a regular at the peer support meetings. “I used to feel accom-

Fran Fabian talks with Dr. Brad Butcher, co-founder of UPMC Mercy’s Critical Illness Recovery Center, during a monthly peer support session for former ICU patients.

caring and listening, responsibility and integrity, and excellence in innovation,” says Eaton. “Our participants come from very different backgrounds, but they bond over common threads of dysfunction they share. It’s such a valuable experience to learn that others are struggling with the same things; some group members wind up

Maria Shoemaker, a staffer at the ICU recovery center, participates in a group for former ICU patients.

Post-intensive care syndrome marked by cognitive and emotional symptoms T

Ongoing, supportive care Programs like UPMC Mercy’s Critical Illness Recovery Center — they number around 20 in the U.S. now — are another piece of post-intensive care syndrome treatment. Patients who have been in ICU at UMPC Mercy for four days or more are personally contacted after discharge and scheduled for an initial three-hour appointment with multiple specialists at the UPMC Mercy recovery center to “tease apart all their issues,” Eaton says.

“We are a hands-on, one-stop shop.

Photos by Nate Langer/UPMC

From page 1

calling to check on each other.”

The peer support group is where Fabian connected with Connie Bovier, 59, who wound up in Mercy’s ICU in May 2018 with pneumonia, septic shock and acute respiratory distress syndrome. She was in the unit for 22 days, during which time she was on mechanical ventilation and placed in a required paralysis in the prone position to ease her breathing. While in ICU, she also sustained an acute kidney injury, had a pulmonary embolism and suffered from stressinduced cardiomyopathy.

Bovier, a single mother of five who supported her family with a job installing and repairing communications equipment, returned home at the end of June 2018 so weak she could barely button a shirt or lift a frying pan.

kelsen, that the term “post-ICU syndrome” was coined to describe the constellation of cognitive and emotional problems that affect patients, from the executive functioning abilities of processing information and planning to memory loss, PTSD-type anxiety and depression, sleep difficulties and stress.

Even more recently, recognition has grown that post-intensive care syndrome impacts families of patients as well.

“There is a ripple effect of strain over time that affects caregivers, who often cope with a loved one’s mental challenges as well as the financial blow that occurs as patients become under- or unemployed due to their inability to return to the kind of jobs they once held,” he says.

— RENEE STOVSKY

plished when I completed a to-do list,” says Bovier. “Now I feel accomplished just making a to-do list.”

Though she experiences tremors in her arm, has difficulty finding her words and suffers from depression and anxiety, Bovier has become a dedicated hospital volunteer, addressing meeting mailers for the ICU recovery center and helping to develop its latest initiative — an ICU journal soon to be distributed to family, friends and caregivers of Mercy ICU patients to help them better understand and remember the time they spend in critical care.

With inspirational quotes by Albert Einstein, the Dalai Lama, Ernest Hemingway and more, each patient’s journal offers room for visitors to share words of support and recollections of the patient’s daily life in the ICU. “Lapses of memory can cause sadness and stress after discharge,” says Butcher.

“We are hoping this diary will improve these psychological symptoms” common to patients with post-intensive care syndrome.

Though Bovier says she has “lots of memories of the ICU — some of them terrifying,” her biggest challenge upon discharge has been “finding a path to move forward.”

“I felt as though I were standing at the base of Mount Everest alone, with the wind howling so loud that I couldn’t hear myself think,” she says. “I knew my best life would be found at the top of the mountain, but I had no idea how to take that first step to climb it.”

Now, she says, she is on her way to the summit, thanks to the help of Butcher, whom she calls her “white-coated Sherpa.”

“He and his team examined my damaged ‘equipment’ — my physical and mental state — and determined the best route for me to take to limit obstacles and time spent on plateaus as I progress higher and higher,” she says. “I am so fortunate to have Mercy’s experts beside me.”