Catholic Health World - January 2021

Well-being resources 2 CHA + Supportive Care Coalition 2 Vaccine ethics 4 PERIODICAL RATE PUBLICATION

JANUARY 2021 VOLUME 37, NUMBER 1

Commander of St. Louis task force leads drive to thwart pandemic

Ministry facilities promote vaccination among staff

By LISA EISENHAUER

ST. LOUIS — It was his proposal that the major health systems tackle the coronavirus pandemic with military precision that Dr. Alexander Garza said landed him in the role of incident commander of the St. Louis Metropolitan Pandemic Task Force.

Ishmael Komara, right, director of nursing at Benedictine Living Community – New Brighton in Minnesota, explains why he got vaccinated against COVID-19 in a video created to educate, reassure and motivate any vaccine-hesitant staffers in the Benedictine eldercare system to get inoculated. View the video at chausa.org/chworld.

By JULIE MINDA

“I am rolling up my sleeves to help protect me and my loved ones.”

“I am rolling up my sleeves so our residents can get back to normal.”

“I am rolling up my sleeves so I can go

and visit my grandma.”

A video from Duluth, Minnesota-based Benedictine features a diverse group of associates from some of the eldercare system’s facilities explaining their reasons for being among the first to be vaccinated against COVID-19. In the video, which the

system created primarily for staff, system President and Chief Executive Jerry Carley says, “The news of a vaccine gives us hope for a new chapter in our fight against this virus.”

As health care organizations across the U.S. initiate mass vaccination efforts among frontline staff, they are simultaneously lighting up education and communication channels to address any apprehension workers might have over being first in line for vaccines developed at unprecedented speed.

The Food and Drug Administration had given emergency use authorization to two COVID vaccines as Catholic Health World went to press early this month. Some Catholic health providers are among employers who have said they will not mandate the vaccinations as a condition of continued employment.

Gaining trust Providence St. Joseph Health is among Catholic systems building trust in the vaccine based on safety and effectiveness Continued on 3

Catholic health systems hop to it as massive vaccination effort begins

By LISA EISENHAUER

Continued on 4

Continued on 5

St. Louis Post-Dispatch

“We were all sitting around the Mercy boardroom and sort of throwing all these thoughts out there, and I, maybe mistakenly, said, ‘You know, there’s a way we can do this,’” recalled Garza, a physician leader at St. Louis-based SSM Health. At the table with him on that February day were representatives from the St. Louis region’s three other anchor health care providers: BJC HealthCare, Mercy and St. Luke’s Hospital.

Colleagues cheered as Greg Newsham, a registered nurse who specializes in wound and ostomy care, became the first of the frontline workers at Mercy Hospital St. Louis to get a dose of the Pfizer-BioNTech vaccine for COVID-19. Newsham was part of the first phase or “A” group in line to get the vaccine because he has been caring for COVID patients, including during the fall surge when the hospital’s daily census included about 100 patients with COVID on an average day.

Across the nation, thousands of frontline health care workers like him stepped up to get the first injection of the two-part vaccine on the first day it was available to them.

Asked if he had any reservations about taking a vaccine that had gotten expedited approval from federal regulators for experimental use, Newsham said, “None whatsoever.”

Staff at Catholic health care systems

Dr. Alexander Garza of SSM Health prepares to provide a media briefing on behalf of the St. Louis Metropolitan Pandemic Task Force in April. He is the group’s incident commander.

Members of the news media surround Rachel Shields-Carnley, a registered nurse and manager of the intensive care unit at Ascension St. John Medical Center in Tulsa, Oklahoma, as she receives the COVID-19 vaccine on Dec. 15. The Tulsa Health Department set up a drive-thru site to administer shots to frontline health care workers.

CHRISTUS Health exec revives a rural Louisiana hospital Medical center thrives by zeroing in on community’s needs, expanding services and access

By LISA EISENHAUER

When Kirk Soileau took over as chief executive of Natchitoches Regional Medical Center in central Louisiana in 2013, the hospital had 57,000 patient touch points a year. In 2019, Soileau that number had climbed to 220,000 even though the population of the city and the parish of the same name have

Workers at Natchitoches Regional Medical Center in Louisiana prepare to test for COVID-19 at an outdoor clinic. The hospital is managed by CHRISTUS Health.

stayed stable at around 17,800 and 38,000, respectively.

Soileau co-led a session at the American Hospital Association’s Rural Health Care Leadership Conference in 2020. In that presentation and in later interviews, he discussed how the 96-bed hospital has managed to expand its services through increased operating revenue while dozens of other rural hospitals have closed their doors in recent years, including at least 17 in 2020.

“Our approach is to find out what do we need to do to be successful and then we do what we need to do to service this community,” says Soileau, who works for CHRISTUS Health, which since 1997 has Continued on 8

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CATHOLIC HEALTH WORLD January 2021

CHA enhances its well-being resources for ministry employees Frontline clinicians and other ees’ emotional and spirihealth care staff have been under tretual suffering.

Gonzales says clinimendous strain since the pandemic hit, and with the recent resurgence cians and other health of COVID infections in many U.S. care staff have endured communities, the stressors are again ongoing trauma, comincreasing for many health care passion fatigue, and workers. burnout during the panTo help Catholic health systems demic prompting many and facilities and other organizations to leave or consider leavsupport overtaxed staff, CHA has ing their professions. He compiled a collection of resources says workers have been on employee well-being. The mateweighted down by fears of contracting the virus, rials include a library of prayers of sadness at witnessing gratitude, a podcast on self-care patient suffering, and practices, a discussion guide on wellworries about their own being, and reflection and meditation finances as a result of the resources. economic downturn.

Accessible at CHA convened a c hau s a. o rg / w e l l task force of nine membeing, the collection includes items crebers with expertise in well-being, spirituality, ated by CHA, minis- A guide to initiating staff conversations about change management try organizations and Gonzales and mission integration national experts on well-being is one of the resources available at that created some of the well-being. chausa.org/well-being. content and provided Dennis Gonzales, CHA senior director of mission innovation and inte- input on the new web collection. The group gration, says while anyone can access the includes physicians.

Task force members Rachel Lucy, resources, the collection might be especially useful to executives in mission, organiza- PeaceHealth director of community health; tional development and human resources Lisa Reynolds, CHRISTUS Health vice presiwho are looking for tools to address employ- dent of change management; and Carrie

Meyer McGrath, CHA director of mission services, created a discussion guide that mission leaders can use to convene and facilitate conversation among staff.

Reynolds says it is theraReynolds peutic for people to talk about what they are going through, and to delve into their fears and blessings. The discussion guide also helps group members

talk through what they are going through and share how and why to practice self-care.

CHA’s Gonzales says that times of trauma can lead to personal growth, and he hopes the resources will help guide ministry associates to this outcome.

Reynolds says, “My greatest hope for these resources is that when someone needs a tool, the resources will be easy to access and staff and leaders will have renewed hope and energy.”

Committee promotes participation in clinician well-being study T

he CHA task force that is addressing associate well-being is encouraging ministry participation in a Catholic university study on the well-being of associates amid the pandemic.

The M. Louise Fitzpatrick College of Nursing at Villanova University is conducting the study, which will examine immediate and long-term impacts of the COVID-19 pandemic on frontline caregivers’ health and wellness. Donna Havens, dean of the nursing school, told the CHA task force the research will add to the field’s understanding of stress, health and recovery following public health emergencies.

Another aim is that the study “inform public health and disaster plans to lessen emotional and physical impacts on health care and essential support workers during future health emergencies,” according to the college of nursing.

To take part in the study, frontline caregivers should visit villanova.edu/CHAMPS. There they will see a link to an online questionnaire that takes less than 20 minutes to complete.

Supportive Care Coalition becomes part of CHA, cementing partnership

By JULIE MINDA

The Supportive Care Coalition, an organization that promotes excellence in palliative care, became part of CHA Jan. 4.

“We will be stronger and better working together on behalf of the seriously ill and those that care for them,” said Denise Hess, the coalition’s executive director, who became director of supportive care for CHA. Hess Sr. Mary Haddad, RSM, CHA president and chief executive officer, said that the coalition’s “commitment to outstanding palliative care in accordance with Catholic teachings and ethical principles is perfectly aligned with CHA’s mission to provide high-quality health care to all persons in need, particularly those who are poor and vulnerable.”

The integration of the coalition into CHA will enhance palliative care programs and services to CHA members and “create a strong and unified voice for enhanced funding and support for outstanding palliative care at the state and national levels,” Sr. Mary said.

CHA and the coalition have been close partners since the Supportive Care Coalition’s 1994 founding. The two organizations have collaborated on national palliative care and advocacy initiatives, and CHA representatives have served on the coalition’s board. Three CHA member systems founded the Supportive Care Coalition, and numerous CHA member systems and facilities are coalition members that participate in the organization’s educational programming and use its palliative care resources.

Based near Portland, Oregon, the Supportive Care Coalition was funded by the dues of its 14 members: the Archdiocese of Boston, Ascension, Avera Health, Benedictine, the Carmelite Sisters for the Aged and Infirm, CHA, CommonSpirit Health, Franciscan Missionaries of Our Lady Health System, Mercy, OSF Healthcare, PeaceHealth, Providence St. Joseph Health, the Sisters of Charity Health System and SSM Health.

Predecessor organizations of Providence St. Joseph and CommonSpirit as well as PeaceHealth founded the Supportive Care Coalition. It was originally called Supportive Care of the Dying: A Coalition of Compassionate Care.

The coalition’s annual budget is about hospice and palliative care.” There also is a $350,000. With the change, CHA members lack of high-quality palliative care services no longer pay membership dues to the in small and rural facilities, she said. These gaps will be addressed by coalition.

“Too many future CHA programming, Hess will work with staff in CHA’s mission, communities of color Hess said.

An ordained Presbyteethics and advocacy pracstill do not have tice areas to develop and rian minister, Hess holds implement programs, master’s degrees in marequitable access to riage and family therapy resources and services to advance palliative care quality health care. and in divinity. She was across the continuum of first drawn to the palliaThis same lack of care in the ministry. tive care field as a clinical Hess said under CHA, pastoral education intern access is true for she expects this palliaat Providence Little Comtive care programming to hospice and palliative pany of Mary Medical Cenreach a much broader ter in Torrance, California. care.” community of caregivShe recalled a patient who was dying of cancer ers. She also expects an — Denise Hess but was in denial about the expansion of the reach of seriousness of her illness, and whose family palliative care services.

“Too many communities of color still do was in turmoil. Hess observed the facility’s not have equitable access to quality health palliative care team preside over a family care. This same lack of access is true for meeting, facilitating “a deep and honest

conversation about this woman’s values, beliefs, joys and sorrows. The meeting led to a plan to help her die at home with her family at her bedside.

“At the end of that meeting, I knew two things,” Hess said: “First, when my time comes to die, I want to be treated with the same compassion and skill. Second, I wanted to work as a chaplain in palliative care and be a part of the re-humanization of serious illness care that had begun several decades ago with the hospice movement.”

Hess has worked in Catholic-sponsored palliative care for a decade. Of her three years with the Supportive Care Coalition, she said, “the greatest rewards have come from watching the new growth and commitment to standing up palliative care programs in Catholic health ministries.

Catholic health care was an early adopter of palliative care and remains a leader in supporting palliative care across the continuum of care.” jminda@chausa.org

Upcoming Events from The Catholic Health Association Community Benefit Networking Call Jan. 12 | 1 – 2 p.m. ET

Sponsorship Webinar: The Sponsor and the CEO – Series One, Session Five Jan. 13 | 2 – 3:30 p.m. ET

Online Foundations for Catholic Health Care Leadership

Seven Consecutive Thursdays, Jan. 14 – Feb. 25

Formation Leader Community Networking Call Jan. 26 | 1 – 2 p.m. ET

Networking Call for Facility Ethicists Jan. 28 | 2:30 – 3:30 p.m. ET

Sponsorship Webinar: Sponsors and the Church, Local and Universal – Series One, Session Six Feb. 10 | 2 – 3:30 p.m. ET

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

January 2021 CATHOLIC HEALTH WORLD

Vaccination education

land, inspired the campaign when she penned an essay on how eager she is to get the vaccine so she may safely hug her grandchild.

From page 1

data from vaccine trials and the urgency of halting a pandemic that had claimed more than 350,000 lives in the U.S. by early January. “And every mechanism we have for communicating that, we’re using,” said Rebecca Bartles, executive director of system infection prevention.

With newsletters, emails, town halls and daily staff huddles, the system is thumping the prevention drum across its 51 hospitals and 29 long-term care facilities in seven states. In a blog post aimed at associates published Dec. 14, Providence St. Joseph Health President and Chief Executive Dr. Rod Hochman wrote: “Immunizing the health care workforce for COVID-19 is a critical step in changing the trajectory of this pandemic and finally getting it behind us.”

In mid-November, Providence St. Joseph surveyed workers about their willingness to get the vaccine. Of those eligible to be at the front of the line because they care for COVID patients, 68% said they would take it as soon as they could, Bartles said.

Dr. Sam Bagchi, executive vice president and chief clinical officer at CHRISTUS Health, said that in a survey of associates across all job categories taken just before Thanksgiving roughly 33% said they would absolutely get the vaccine, around 30% said they were unsure and just under 40% said they weren’t interested. He said that the number of associates open to being immunized appears to be growing.

“As we start to preregister people to actually receive the vaccine, it appears higher numbers than we initially estimated are going to opt in,” Bagchi said just days before CHRISTUS started inoculating staff in mid-December.

Ear to the ground Catholic health care providers are mining employee feedback to gain a more nuanced understanding of confidence or hesitancy about the vaccine and refine their communications strategies accordingly to address concerns.

In addition to having sent out a formal survey at the start of December, Avera Health is monitoring how many employees sign up for vaccination clinics as they are offered, and the system will be working with leadership at facilities where there is low uptake, to learn why employees are not signing up and to talk through any related questions, said Dr. David Basel, vice president Basel of clinical quality for Avera

Family practice geriatrician Dr. Jaspinder Dhillon, left, and dentist Dr. Azalpreet Dhillon check in to receive their COVID-19 vaccine at the Jennings eldercare campus in Garfield Heights, Ohio, where they are contracted to treat patients.

Medical Group.

Dr. Neal Buddensiek, chief medical officer of Benedictine’s senior living communities, said, “We need to get that trust (in the vaccines) as high as we can. We’re helping people gain comfort with the vaccine by educating, educating, educating.”

Buddensiek said to close in on herd immunity, Benedictine Living Communities will need to vaccinate 70 – 80% of their on-campus population, including staff and residents. “We must keep in mind that until the community at large outside of Benedictine has achieved herd immunity there will still be the possibility, although markedly reduced, for the virus to be transmitted within a Benedictine Living Community thereby causing an outbreak and possible morbidity and mortality,” he said.

Communications blitz Health systems throughout the ministry have organized task forces that have tapped into virtually every available communications channel to reach staff, including informal and formal meetings among leadership and staff, and dissemination of factual information through Zoom meetings, social media posts and print communications.

Allison Q. Salopeck, president and chief executive of the three-campus eldercare system Jennings in Garfield Heights, Ohio, said, “We are reaching out in any ways we can think of Salopeck to educate staff.”

Vancouver, Washington-based PeaceHealth had hosted six virtual town halls by the start of the year, with more than 4,300 caregivers participating, and many more listening to recordings of the meet-

ings. “We are answering questions in the town halls and then expanding FAQs constantly to be distributed to all caregivers,” said Jeremy Rush, PeaceHealth manager of public affairs. PeaceHealth has tailored the FAQ document for use on its website for patients and community members.

The 50-hospital Bon Secours Mercy Health system of Cincinnati is providing its vaccine information to staff on a dedicated intranet page.

Sioux Falls, South Dakota-based Avera Health — which has 35 hospitals, 40 eldercare facilities and a network of outpatient sites — has an email address where employees can submit questions about the vaccine.

Avera’s Basel said he and other system executives are talking to the media and to community leaders about the efficacy and safety of the vaccine, knowing that those communications also should reach employees.

Kathleen Murray, the Benedictine staff lead coordinating the “Let’s Roll Up Our Sleeves” campaign, said it includes a communications packet for the system’s 32 senior living campuses with talking points for leaders, a Murray customizable letter for staff and another for residents and their families, and posters and stickers promoting vaccination. Murray said Benedictine is debunking conspiracy theories and misinformation circulating on social media about the vaccines at its town halls.

Trinity Health Senior Communities is running a contest called “Hope for Hugs,” in which staff write a short essay explaining why they want to get vaccinated. Jan Hamilton-Crawford, president of Trinity Health Senior Communities of New Eng-

Practical concerns Justin Hinker, administrator at the Avera Prince of Peace long-term care campus in Sioux Falls, said he’s not hearing about vaccine resistance from staff at his facility but he is fielding many questions, particularly about practical concerns such as how the vaccine is administered, the side effects, the cost (employees will not pay out of pocket) and the length of time of immunity. The questions mirror those he gets during flu vaccination season.

Benedictine’s Buddensiek said he’s heard some concerns from staff who are pregnant or post-partum. There is not yet data on the safety of the vaccines during pregnancy, and so Benedictine will be monitoring data to answer those questions.

Basel at Avera and Salopeck at Jennings said their systems had gotten word that some staff and residents were concerned about whether materials used in the development and production of the vaccine were ethically obtained. These leaders said they’ve been appreciative of resources from CHA and other faith-based groups that clarify that the Catholic Church finds that it is morally acceptable to take the Pfizer-BioNTech and Moderna vaccines.

(See related story page 4.) Those vaccines were neither developed nor produced with fetal stem cell lines, according to Brian Kane, CHA senior director of ethics.

First in line Salopeck noted that if there is vaccine hesitancy or suspicion among long-term care staff, it may be because they are not used to long-term care being put at the front of the line when it comes to public health.

Buddensiek has heard similar sentiments. He said his message to those who can get the vaccine in the near term is this: “What we are doing now — the tight restrictions, the isolation — it is not solving anything.”

According to the Centers for Disease Control and Prevention, deaths of longterm care patients and staff account for nearly 40% of COVID deaths.

“We have had outbreaks in the majority of our facilities at this point,” Buddensiek said. “We want to be part of the solution.

We in long-term care are usually not at the start of the line. Now (with the vaccine) we are. And so, let’s help lead for the world, let’s be part of the solution.”

Lisa Eisenhauer contributed to this report. jminda@chausa.org

Ministry systems promote vaccine acceptance among minority staff

W

hen Jan Hamilton-Crawford received her COVID-19 inoculation from a CVS pharmacy worker on Dec. 28 at Saint Mary Home in West Hartford, Connecticut, a public relations representative from Trinity Health Senior Communities of New England was on hand to capture the moment on video.

Hamilton-Crawford, Hamiltonpresident of Trinity Health Crawford Senior Communities of New England, had volunteered to be the first in that system to receive the vaccine and to talk about its safety and efficacy in a video to be shared with employees.

Surveys show a very low acceptance of the vaccine among Black people, HamiltonCrawford said, and as a Black health care executive she wanted to be part of an effort to offer assurance of its value and lead by example.

Hamilton-Crawford said that in general, Blacks believe the health care system has not always been equitable to them and has, by virtue of some notorious research experiments, caused preventable harm that

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destroyed the trust of generations. She said that, combined with the fact that COVID-19 disproportionately devastated the Black community, has resulted in fear and reluctance about the vaccine.

Given that trepidation, it is important to reach out to minority employees of Trinity Health Senior Communities with factual information about the COVID-19 vaccines, she said.

“Since many colleagues on the front lines — CNAs, housekeepers, laundry workers, and dietary personnel — are people of color whose roles are pivotal to making the health care system work, it is critical to educate them about the safety and efficacy of the vaccine.

“Blacks tend to get their medical information from trusted sources. Those trusted sources tend to look like us. Getting the vaccine is no different. Blacks are looking for sources and people with whom they can relate. In my role as a trusted health care leader, I have the opportunity to educate, because I am often tapped to speak both formally and informally to the Black community.

“With the vaccine, I have the opportunity to direct people of color to seek out accu-

rate and proven data from reliable trusted sources” like the Centers for Disease Control and Prevention and state departments of public health, she said.

“This vaccine is hope itself, and I want to be a part of spreading belief in that hope as far and wide as I can,” Hamilton-Crawford said.

Other ministry systems and facilities also are being intentional about communicating with employees of color to gauge their comfort level with the vaccine and to try to address concerns they may have.

Brian Reardon, CHA’s vice president for communications and marketing, said there is widespread recognition among ministry marketing executives throughout the U.S. of the need to seek out the perspectives of people of color and adapt vaccine education campaigns to reach vulnerable Reardon communities.

One way ministry systems and facilities are doing this is to include images of people of color receiving the vaccine when they host vaccine media events. “Showing a diverse

group of people getting vaccinated also sends an important message that we’re all in this together when it comes to slowing the spread of the virus,” he said.

Allison Q. Salopeck is president and chief executive of the three-campus eldercare system Jennings in Garfield Heights, Ohio. She said a large percentage of frontline staff at Jennings are Black, and she and other leaders are aware of the potential for vaccine hesitance rooted in mistrust of the medical system. Jennings is taking steps to ensure that minority staff see acceptance of the vaccine among people of color.

Bon Secours Mercy Health, based in Cincinnati, has been working with its internal diversity and inclusion experts to ensure associates feel comfortable expressing concerns about the vaccine and that those concerns are addressed. That system has developed a frequently asked questions document tailored specifically to racial and ethnic minority populations.

Visit chausa.org/chworld to view the Hamilton-Crawford video.

—JULIE MINDA

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CATHOLIC HEALTH WORLD January 2021

Ethicist says COVID vaccine plans align with Catholic teachings Many ethical considerations have arisen regarding the development and distribution of vaccines for COVID-19. Catholic Health World Associate Editor Lisa Eisenhauer asked Jason Eberl, a professor of health care ethics and director of the Albert Gnaegi Center for Health Care Ethics at Saint Louis University, for his perspective on some of those issues.

What are your thoughts on the recommendations to the Centers for Disease Control and Prevention from its Advisory Committee on Immunization Practices that frontline health care workers and residents and staff at long-term care centers should be the first to get the COVID-19 vaccine?

It seems logical to me to prioritize health care workEberl ers, those in essential positions. When you’re dealing with a public health crisis, there is a relevant principle, the common good, to focus first on those who, if they are to get sick and are unable to work, would have a multiplier effect on care for others. We all benefit from those who care for us being protected first, plus there is an argument that we owe it to them as reciprocity for having put their health and lives on the line for us.

What do you see as the major ethical issues related to any COVID vaccine?

If we’re talking about any vaccine in general, of course, one of the first issues from a Catholic perspective is: Was the vaccine developed in an ethical manner? There are some vaccines that are built using cell lines that were developed about 40 years ago from tissue from aborted fetuses. Back in 2005, the Congregation for the Doctrine of the Faith issued a statement (reaffirmed in the 2008 document “Dignitas Personae”) basically stipulating that while it’s unethical to develop vaccines from those cell lines, it is permissible for people, if they have no other alternative vaccine available to them, to utilize that vaccine.

Garza From page 1

COVID-19 was being reported in New York and Washington state and had started its sweep across the globe.

Garza proposed using a military decision-making process to defend against COVID: anticipate and define the problems, set end goals and lay out steps to get there.

Garza said it was clear to him that what was needed was a unified effort to get all of the cogs and gears moving in sync.

The group agreed to pool their efforts and mount a unified offense coordinated with government and public health leaders.

They created the task force, tapping Garza as its leader.

“They said, ‘OK, you’re our guy,’” Garza recalled. “I was like, ‘Wait a minute, I merely offer suggestions.’ But I thought, we need to have a single voice leading this, and a single sort of identified point to make this all happen. So, they asked me if I would do it, and I said of course I would.”

Meet the press Since early April, Garza has overseen the sharing of best practices, data and resources among the health systems, and he’s been the public face of the pandemic response in the greater St. Louis area. His thrice-weekly media briefings — streamed live on Facebook and often on local news websites — have propelled him into regional celebrity status as a voice of reason.

Garza, 53, said he hopes his briefings are keeping the public informed of the pan-

historical basis to justify distrust. But, looking at the present day, while there’s still a great deal of health disparities experienced by various minority groups, people of color in particular, we have very robust research regulations that are specifically in place to protect exploitation of members of these groups again. From what I’ve seen in terms of how they have enrolled people in the vaccine studies — there were over 40,000 people in the case of the Pfizer study — there was no exploitation happening. Therefore assuming adequate review by the Food and Drug Administration, I don’t think that that history justifies the present attitude of distrust about this particular vaccine.

Dr. George Diaz, section chief, infectious diseases at Providence Regional Medical Center in Everett, Washington, shows the bandage on his arm where he got his COVID-19 vaccine injection. Diaz was the first doctor to treat a patient confirmed to have COVID in the United States and the first doctor in the world to administer the antiviral drug remdesivir. The hospital is part of Providence St. Joseph Health.

Thankfully, the Pfizer and Moderna vaccines do not have this ethical issue. The AstraZeneca one does, but the Congregation for the Doctrine of the Faith has just affirmed the previous teaching allowing for Catholics in good conscience to be vaccinated by any of the available vaccines, even if they were produced through immoral means.

Any other issues?

The next major issue has been about making sure that we are adhering to principles of a just, equitable distribution of resources. CHA has published ethical guidelines in this regard, calling, first of all, for demonstrating the safety and efficacy of the vaccines, and then assuring that the decisions on prioritized distribution of vaccine are consistent with Catholic social principles including the dignity of the human person, the common good, subsidiarity and the preferential option for vulnerable persons.

When you look at the common good and the preferential options for vulnerable persons, what the CDC has recommended makes sense to me, including the most recent call for those over 75 years of age and frontline

demic’s human toll and educating people on the importance of social distancing and masking to reduce the infection risk for themselves and others.

The task force has its roots in a brief email Garza got from Dr. Clay Dunagan asking to talk about the pandemic.

Dunagan, BJC HealthCare’s chief clinical officer, is that system’s representative on the task force. He said Garza has been nothing short of spectacular as its leader.

Dunagan “He’s unflappable,” Dunagan said. “He’s very smart and extremely committed and the guy is just really courageous. He will lean right in even when he’s facing tough resistance, but he always does it in a very respectful and kind way. I think he has that great combination of being extremely effective but also a very nice person to deal with.”

Dunagan recalled talking with Garza when Garza was returning to his native St. Louis from working in Washington. “I had a chance to interview him and just knew what an extraordinary background he had,” Dunagan said. “At that time, I said, ‘You know if we ever have a major disaster in STL, I know who I’m going to call first.’ I didn’t think I would ever have to do that, but it turned out to be the right time.”

The right stuff Garza is uniquely suited to the moment. A specialist in emergency medicine, he joined the U.S. Army Reserve Medical Corps during his residency. His more than 20 years with the Reserve has included serving a yearlong

workers in essential industries to be vaccinated in the next round.

Does the U.S. have a duty to ensure people without legal immigration status in the U.S. have access to the vaccine?

I don’t think prioritizing citizens over noncitizens is ethically justifiable since there is no principle of Catholic social teaching that justifies this form of discrimination.

Plus, if one looks at it from a pragmatic perspective, then ensuring maximal vaccination makes sense, because it protects all of us in the end.

COVID has hit communities of color especially hard, and those communities have been the victims of poor care and maltreatment by the American health care system. Is there justification for people in communities that suffered inequities in care to be suspicious about getting a vaccine?

Given the history of egregious unethical treatment of people of color in the U.S. by the medical community, including the infamous Tuskegee syphilis study by the U.S. Public Health Service, I think there is a

Does the U.S. have a special duty to build trust among vaccine sceptics in communities of color?

Yes, through education. Honest information, transparency, going out to local communities, talking with local church groups and so on, I think, is imperative to educate people, especially when there’s so much misinformation being put out through the internet, through disreputable media sources.

What is our responsibility to people in prisons and jails with respect to vaccine distribution?

The incarcerated have as equal a right as those of us who have not been convicted of a crime to receive access to the vaccine.

Do we as a nation have a responsibility to share any vaccines that we develop with poorer nations that don’t have the same resources?

Absolutely. Pope Francis, in his recent book Let Us Dream and elsewhere, has called on us to adopt a global perspective, recognizing that we are all brothers and sisters in Christ, baptized or not, whatever country we live in. The preferential option for the poor and vulnerable extends beyond any national borders. And, from a purely pragmatic perspective, people travel, and part of the reason the virus spread so quickly is major global travel. If we want to resume that level of global travel then it is in everyone’s best interest to share the vaccine.

Dr. Alexander Garza, right, of SSM Health is interviewed by Chuck Todd of NBC News. Garza leads the pandemic response by major health care providers in the St. Louis region.

tour in Operation Iraqi Freedom. He was in charge of a team tasked with rebuilding Iraq’s health care system and his work led to various honors, including the Bronze Star, and to his rise to his current rank of colonel. Since 2009, he has served as command surgeon for the Reserve’s 352nd Civil Affairs Command (Airborne) based in Fort Meade, Maryland.

He was appointed by President Barack Obama and confirmed by the Senate as chief medical officer and assistant secretary for health affairs with the U.S. Department of Homeland Security, serving in that capacity from 2009 to 2013. Part of that job was monitoring emerging health threats and creating plans to address how a severe pandemic might affect national security. He and his team put together a playbook for pandemic response when the H1N1 virus was spread-

ing. It covered acquiring personal protective equipment and distributing vaccines.

In 2013, he moved to St. Louis with his wife and three sons to become associate dean for public health practice and an associate professor of epidemiology at the Saint Louis University College for Public Health and Social Justice. Five years later, he accepted a position as SSM Health’s chief medical officer. In August, he took the newly created job of chief community health officer for SSM Health. He is responsible for deepening the health system’s focus on social determinants of health, equity and social justice, as well as supporting its pivot to population health and valuebased delivery.

No easy task “I think the chief community health officer asks how does the health care system

January 2021 CATHOLIC HEALTH WORLD

Vaccination effort

FDA approval and was being rushed to inoculation sites, including some Providence St. Joseph Health facilities. Moderna’s twodose vaccine does not require super-cold storage temperatures.

From page 1

spent weeks submitting the necessary applications for allotments of the vaccine and putting in place processes for inoculating their workforces. Ministry health systems are hopeful that most employees will get the vaccine and that the inoculation assembly line will go smoothly, as it did on Dec. 14 during the first run at Mercy Hospital.

Workers eager for shots Steve Frigo, executive director of pharmacy for Mercy Hospital, called the first day a “soft opening” for the COVID vaccination clinic with only a few of the eight stations in use. It was in operation in an auditorium for a few hours that day and the next as a runthrough to see if any kinks needed to be worked out. Frigo said there were none as the 975 doses the hospital got in its first shipment began to be dispensed. By the end of the month, the clinic was open from 7 a.m. to 7 p.m. for frontline staff.

Frigo was confident the hospital would use up the shipments it expects to get weekly as they come in. The Pfizer vaccine requires a second dose 21 days after the first. “When we started talking about looking for people who wanted to sign up on our first day in our A group, we had an overwhelming number

Frontline workers at SSM Health DePaul Hospital take a moment to pray before getting their first COVID-19 vaccinations at the suburban St. Louis hospital on Dec. 17.

of people who wanted to get in,” he said. “It’s very exciting to see that.”

In the first stage of distribution with vaccine supplies limited, federal guidelines call for the vaccine to go to nurses, doctors, respiratory therapists, housekeepers and other staffers who are providing direct care to COVID patients or potentially exposed to infectious material. First priority is also being given to residents and workers at long-term care facilities, which have been ravaged by COVID and account for a dispro-

A clinician at Providence Alaska Medical Center in Anchorage gets a COVID-19 vaccine from a colleague.

interact with the community in order to help the community be more healthy?” Garza said. “And that isn’t through just the delivery of health care.”

For almost two decades, researchers have been making the case that health care impacts only about 10 – 20% of preventable mortality in the U.S. Health care systems increasingly are recognizing the impact of social factors including educational opportunity, safe housing and streets and the availability of stable, living-wage jobs on health outcomes and longevity.

“I think more and more people are beginning to understand that this is really the only way that we’re going to be able to sort of move the population in order to improve their health,” Garza said. “It seems so simple, but it’s not. It’s very difficult work, and it’s much more about policy work than it is about access to health care.”

The pandemic’s long tail Garza is looking toward the COVID vaccines as the start of the end of the pandemic.

But even as the inoculation process was beginning, he saw the crisis as far from its end. “There is going to be a lot of sick people and a lot of death between now and then,” he said.

And even if the vaccines bring the pandemic to heel, he warned that its effects on the nation will linger because of the many survivors whose health has been diminished and in some cases wrecked by the virus and because of those, including health care workers, who have been traumatized. “When you get into these situations, you don’t think about what is going to be the long-term

5

portionately high concentration of deaths.

The guidelines recommend that the second phase of vaccinations go to “frontline essential workers” such as firefighters and grocery store clerks, and anyone aged 75 or older.

As of Jan. 5, there were 17 million doses distributed nationwide and 4.8 million vaccinations given, according to the Centers for Disease Control and Prevention.

At large systems like Providence St. Joseph Health, which operates 51 hospitals in seven Western states, tens of thousands of staffers are eligible to be at the head of the vaccine line. Rebecca Bartles, executive director of system infection prevention, said the system had given more than 50,000 firstround vaccinations by Dec. 30. Bartles said Providence Bartles St. Joseph Health was getting its expected allotments of vaccines and able to offer shots to all frontline workers considered at high risk. “Our caregivers have been eager to receive the vaccines,” Bartles said.

“It’s given everyone hope during these trying times.”

As part of the prep work for the vaccine, the system bought commercial-grade ultracold freezers needed for long-term storage of Pfizer’s vaccine. “They are a hot commodity right now and they’re not inexpensive,” Bartles said of the appliances.

By mid-December a second vaccine, this one from Moderna, had gotten emergency

effects until you’re there, but you can see it.

In one of the ICUs, Garza asked Nurse It’s very plain.”

Manager Angelo Lavelle how the staff was As the pandemic was filling up ICUs in the holding up amid the relentless surge of St. Louis region in early December with no COVID patients. “They’re tired, I’m not going sign of a letup, Garza to lie to you,” Lavelle visited staff in the replied.

“He’s very smart and emergency departHours later, durextremely committed and the ment and ICUs at ing a task force media SSM Health DePaul guy is just really courageous. briefing, Garza said Hospital in suburban on average 20 people St. Louis. It was one of He will lean right in even when were dying of COVID the SSM Health facilieach day in the he is facing tough resistance, region, three times as ties with the highest number of COVID but he always does it in a very many as in the worst days of spring. “As I patients. A refrigeraspoke with our teams tor truck was parked respectful and kind way.” at DePaul Hospital in the back lot to — Dr. Clay Dunagan today, they were tellfunction as an overflow morgue. Garza ing me that someoffered beleaguered staff his deep gratitude times they feel hopeless when they see a for their courage and sacrifice. patient take a turn for the worst, because they’ve seen it so many times before, that the patient will not be discharged from the hosBully pulpit On the day of the visit, SSM Health DePaul pital,” he said.

Hospital had doubled up patients in some of He then admonished Missouri’s governor its ICU rooms to make space for more COVID and other elected officials for not adopting patients and its clinicians were bracing for a public health measures including mandaspike in admissions because of Thanksgiving tory mask rules and safer-at-home policies travel and gatherings that spread infection. that have proven effective in other states Garza’s presence reassured staff. “He is at checking the spread of the virus. He also the calm in the storm,” said Dr. Sriram Vissa, urged the public to remain vigilant in followSSM Health DePaul Hospital’s vice president ing infection precautions. of medical affairs and chief medical officer.

Speaking to the viewing public, he said: “I’ve never seen him become angry or emo- “We are still fighting this battle without all tionally ruffled. I’ve seen him vulnerable to the weapons and tools that we need. Now, I the tragedy that’s going on around us. He has hope that changes, but until it does, you are had his moments, as any human would, with our best hope that we have to slow the virus tears and that kind of emotional response and to buy the time that we need.” but not, I would say, emotional swings.” leisenhauer@chausa.org

State-by-state challenges Health systems have had to navigate the separate structures each state devised for divvying up their vaccine allocations from the federal government. Bartles said the processes vary vastly by state. “The state-level complexity has really added a lot of flavor to this recipe,” Bartles said. “And the fact is that some states are incredibly active and forward-thinking and responsive, and others are on the other side of that, and so it’s been just a really trying process.”

Providence St. Joseph Health loosely based its COVID vaccination process for staff on the one it uses for flu vaccines. Associates were being notified when they quali-

A medical worker holds a vial of the Moderna vaccine, one of two vaccines that federal regulators had approved for COVID-19 as of early January.

fied in the priority roll-out and could proceed to one of the vaccination clinics to get their shot. The vaccines are being tracked in the employee record system.

At its long-term care centers, the system relied on the partnership set up by the Centers for Disease Control and Prevention with Walgreens, CVS and other pharmacies to administer the vaccines.

Planning for quick work Dr. Sam Bagchi, executive vice president and chief clinical officer at CHRISTUS Health, said the leeway the federal government gave to the states to set up their own distribution processes, while Bagchi making the process more complex, has had something of a silver lining in that states have been allowed to be innovative.

“It’s been good to see different states try different things,” he said. “What would be nice to have is a clearinghouse to say, here’s the practices that work the best and that’s going to become the new national standard.

Right now, I don’t see that clearinghouse available to share those best practices.”

David Benner is vice president of clinical ancillary services for the division of clinical excellence at CHRISTUS Health, which has facilities in Texas, Louisiana and New Mexico. He said the system planned to administer as many doses as possible of the vaccine quickly because that would in part affect how many doses it gets in future weekly allotments.

In a social media post updated on Dec. 31, CHRISTUS Santa Rosa Health System in San Antonio said it was starting to vaccinate people in the “Phase 1B” group.

Texas’ definition of the group includes those age 65 and older and adults with existing health issues. “However, as our hospitals continue to care for patients with COVID and other medical needs, we are working to turn this process over to specific clinics and outpatient care locations, which are better prepared to provide this type of care to large groups of the public,” the post said.

Back at Mercy Hospital St. Louis, part of the four-state Mercy midwestern system, Newsham had a message for colleagues and the public: “Take the vaccination. Let’s get this healing process started.” leisenhauer@chausa.org

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CATHOLIC HEALTH WORLD January 2021

Benedictine tests intervention that takes patients into virtual realm

By PATRICIA CORRIGAN

Adapted from the entertainment and gaming worlds, virtual reality now has applications in health care as an alternative to pharmacological treatment. Using a headset while seated, patients can experience a walk in the woods, a swim with dolphins or a tour of Paris. The distraction that these and other immersive computer-generated simulations provide has been shown to offer comfort and reduce physical and psychological pain.

Benedictine, a senior care system based in Duluth, Minnesota, uses VR therapy at four of its 30-plus care centers across the Midwest with individuals living with chronic pain, physical disabilities or dementia.

“We’re about 16 months into our first test with VR therapy, starting small, but moving fast,” said Dr. Neal Buddensiek, Benedictine’s chief medical officer. “Digital health aligns with what we want to be. As we work to drive excellence Buddensiek in supportive and palliative care, we want to find and offer more diverse non-pharmaceutical interventions.”

Currently, Benedictine uses VR therapy with about two-thirds of residents at the Benedictine Living Community – Regina in Hastings, Minnesota, and has expanded its use to three other sites. They are Benedictine Madonna Meadows in Rochester and Benedictine Living Community – Red Wing, both in Minnesota, and Villa St. Benedict in Lisle, Illinois.

“At Regina, VR therapy is an as-needed treatment for patients with dementia, used as a life-connecting diversion,” Buddensiek said. “At Villa St. Benedict, we’ve set it up as a therapy that can be checked out by the assisted-living tenants.” One resident noted that a VR travel experience brought back great memories; another reported loving “the adventure.”

‘An added intervention’ So far, Buddensiek said, VR therapy has worked for some patients, but not for others.

“This is a test,” he said. “Many patients are

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co-founder of MyndVR. “We’re not making health claims, but the research is promising and we’re excited about aligning content models with age-related conditions so we can use VR therapy to improve people’s lives.”

The MyndVR headset displays immersive, computer generated images such as nature videos.

Benedictine is testing whether the therapy benefits elderly patients who are in physical or psychological pain.

enjoying it because it helps with social isolation and with the different domains of pain — physical, emotional and psychological.

I see this as an added intervention, and it’s not negatively impacting anyone.”

This particular test commenced in June 2019, when Benedictine signed a twoyear contract with MyndVR, said to be the nation’s leading provider of VR programming for seniors. Based in Dallas, the company has contracts with senior centers across the country and has reported positive outcomes from a nationwide pilot program conducted at senior living communities in New York, California, Texas, Florida and Kansas. MyndVR recently launched new studies with Stanford University and the School of Nursing at the University of Pennsylvania.

“Basically, we’ve reimagined VR away from the Brickler gaming culture and commercialized it for use as a healing modality,” said Chris Brickler, chief executive and

Creating wonderment One study Brickler cited, conducted at Indiana University, showed that patients using VR therapy in intensive care units experienced decreased delirium, less pain and enhanced mood. Tests on individuals in memory care revealed increases in “socialization, discernment and deduction” and also “an increased sense of belonging and wonderment.”

MyndVR’s newest content offering, released in September, is “7 Miracles,” a 70-minute, immersive VR adaptation of the seven miracles of Jesus Christ based on the Gospel of John. The seven-part feature is the result of MyndVR’s partnership with HTC VIVE, a VR platform. Brickler noted that Benedictine was the first senior care provider to make “7 Miracles” available, and he looks forward to expanding the company’s faith-based offerings.

Buddensiek said Benedictine chose to work with MyndVR because of the diversity in the company’s content library. “With that content, we have the potential to engage a resident in ways relevant to his or her life story,” Buddensiek said. “In one instance, a patient’s spouse told us his wife might like a VR experience of going to a piano concert.

After the session she was engaged, present in the moment and spoke quite a bit about what she had experienced. Her spouse found all this remarkable, as his wife rarely spoke.”

Grandson shows the way Benedictine staff is using VR therapy for one patient with a traumatic brain injury and for another during dressing changes for leg wounds.

Buddensiek reported one unexpected victory, which occurred before COVID-19 visitor restrictions were in place.

When a patient was reluctant to put on the headset, one of her grandchildren, visiting that day, volunteered. “He loved it, and was laughing a lot,” Buddensiek said. “When he finished, his grandmother said she was ready to try it, so we had some socialization there that otherwise might not have happened through this shared experience.”

VR therapy can be especially useful in dementia care. As an example, Brickler noted that the agitation some patients experience as day turns to night, known as sundowning, can require extra staff time and medication. “Intervening with VR therapy before it starts can help bring consciousness back into connection with nature or music and art,” he said.

Caregivers at Benedictine have reported that they consider VR therapy “a worthwhile and valuable intervention,” Buddensiek said. Benedictine also provides integrative health treatment options, including music therapy, aromatherapy and therapy dolls.

“Just as with our holistic therapies, with VR we are providing support and finding solutions to help with symptoms,” he said.

“We’re still learning and growing with this, but our hope is that a prescriptive boost of VR therapy every so often will comfort and support our residents better and provide a greater quality of life — even when they are not in the headsets.”

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7

Dr. Treffert was a foremost researcher of autism, savant syndrome Dr. Darold Treffert died Dec. 14 at age 87. He was an internationally acclaimed researcher in autism, hyperlexia, savant syndrome and related conditions and the inspiration behind an Agnesian HealthCare center that promotes the abilities of people who have these conditions.

Treffert’s work was published in more than 50 professional journals and featured in TIME, People, Newsweek and on “Oprah,” “60 Minutes,” and other network programs.

He wrote several books on autism and savant syndrome.

Treffert was born in 1933 at St. Agnes Hospital in Fond du Lac, Wisconsin, which today is part of Agnesian HealthCare, a member of St. Louis-based SSM Health.

He graduated from the University of Wisconsin Medical School in 1958 and completed his psychiatric residency at the

University Hospital in Madison, Wisconsin.

Treffert developed the child and adolescent unit of Wisconsin’s Winnebago Mental Health Institute in 1962 and was superintendent of that institute from 1964 to 1979.

It was there that he met his first savants and developed his interest in researching the condition.

Treffert worked in various clinical roles with St. Agnes Hospital and the Agnesian HealthCare system during his career, including as medical director of the alcoholism rehabilitation unit at St. Agnes. He served on multiple Wisconsin medical boards and was a clinical professor at the University of Wisconsin Medical School and the University of Wisconsin–Milwaukee.

Treffert was a script consultant for the movie “Rain Man,” winner of the Oscar for best picture of 1988.

Dr. Darold Treffert

He retired in 1991 but continued his research.

In 2016, Agnesian HealthCare established the Treffert Center on the St. Agnes campus to preserve and expand Treffert’s body of work, including books, recordings, documentaries and artwork he collected or created. The center has evolved to include a library, a clinic and an academy where children with developmental conditions and children who are neurotypical learn side by side.

Dr. Matt Doll is Agnesian HealthCare’s director of behavioral health services/ autism. He said in an announcement on Treffert’s passing that Treffert’s “kindness, genuine compassion and lifelong curiosity were evident in all he did.”

Information on the Treffert Center is available at treffertcenter.com.

Starmann-Harrison to retire midyear as HSHS president and chief executive Mary Starmann-Harrison plans to retire in the second half of this year as president and chief executive of Springfield, Illinois-based Hospital Sisters Health System.

She has worked in Catholic health care leadership for Starmanntwo decades — half that Harrison time as the top executive of HSHS, which has 15 hospitals in Illinois and Wisconsin.

In an announcement on the retire-

ment, Sr. Jomary Trstensky, OSF, said that, in everything she undertook, StarmannHarrison “acted with passion and with a personal investment in the underlying HSHS mission.” Sr. Trstensky chairs Hospital Sisters Ministries, the public juridic person of HSHS. Born and raised in the Chicago area, Starmann-Harrison earned a bachelor of science in nursing from Arizona State University and began her health care career as an emergency department nurse. She received a master’s in health service admin-

istration from Arizona State before joining St. Luke’s Medical Center in Phoenix. She was chief executive of that medical center from 1988 to 1997. She was chief executive of the western region of Tenet Physician Services of Phoenix from 1997 to 1998. And she was president and chief executive of SSM Health’s Wisconsin region from 1998 to 2011.

Under Starmann-Harrison’s leadership, HSHS has grown, adding three hospitals, expanding HSHS Medical Group, Prairie Cardiovascular and a partnership with the

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Prevea Health physician group, and creating numerous partnerships and affiliations. Bill Murray, HSHS board chairman, said in the retirement announcement that Starmann-Harrison has overseen this growth “with a clear vision of establishing a high-quality and integrated model of care for the communities we serve.”

Starmann-Harrison is a member of the board of governors of the American College of Healthcare Executives. She is a past chair of the Wisconsin Hospital Association and chaired and remains a member of the Illinois Hospital Association board. She was on the American Hospital Association’s board.

HSHS is working with the Korn Ferry consultancy to identify StarmannHarrison’s successor.

KEEPING UP PRESIDENTS/CEOS

Jeremy Fotheringham to president of SSM Health’s academic ministries in St. Louis, including SSM Health Cardinal Glennon Children’s Hospital, SSM Health Saint Louis University Hospital and SSM Health St. Mary’s Hospital. He was chief operating officer for a network of five hospitals and more than 60 medical group locations that are part of University of Missouri Health Care.

Debbie Streier to regional president and chief executive for Avera Marshall Regional Medical Center, effective Feb. 1. She will have leadership responsibilities over Avera Marshall Regional Medical Center in Marshall, Minnesota; Avera Tyler in Tyler, Minnesota; and Avera Granite Falls Health Center in Granite Falls, Minnesota. Streier currently is vice president of operations at Avera St. Luke’s Hospital in Aberdeen, South Dakota.

Organizations within Chicago-based CommonSpirit Health have made these changes: CommonSpirit Health recently expanded its Southwest Division. Julie Sprengel continues as division president overseeing Dignity Health hospitals in California’s Los Angeles County and San Bernardino County, and in Nevada’s Clark County.

Sprengel Joining the newly formed division will be Dignity Health hospitals from Central Coast and Central California.

Chuck Cova is departing during the first quarter of this year as president and chief executive of Marian Regional Medical Center of Santa Maria, California, and of Dignity Health Central Coast Division in California.

Daryn Kumar to president of Dignity Health’s Saint Francis Memorial Hospital and St. Mary’s Medical Center, both located in San Francisco. He has been chief operating officer at Dignity Health’s Mercy San Juan Medical Center in Carmichael, California, since February 2019.

8

CATHOLIC HEALTH WORLD January 2021

Rural innovator

Institute grooms, retains emerging leaders K

From page 1

managed the not-for-profit communityowned hospital. The hospital is overseen by a seven-member board appointed by the parish president. Soileau is the hospital’s only CHRISTUS Health employee.

The community hospital has recruited specialists and opened a primary care and a walk-in clinic along with specialty clinics.

It is contracting directly with several large employers including the city and the parish to provide urgent care. It also worked with state and federal officials to secure changes that improved access to care for low-income patients and upped insurance reimbursements. Last year, the hospital had capital projects totaling about $15 million underway or completed.

Soileau says the service expansions haven’t changed the nonprofit medical center’s bottom line. It remains a break-even operation, but it provides many more services in the community than before. In addition, since 2013 its staff has grown from 430 with a payroll of $22 million to 830 with a payroll of $37 million.

Listening to the community Shortly after he accepted the hospital’s top job, Soileau went on a listening tour. “I got in front of every constituent group and said: ‘What do you need? What are you hearing? Tell me,’” Soileau recalls.

The consensus was that the hospital wasn’t seen as a good choice for health care.

That was backed up by analytics that showed 82% of residents were leaving town for services the hospital provided. (Patients from the Natchitoches area have always gone to CHRISTUS Health hospitals in Shreveport or Alexandria for tertiary care; both cities are more than 50 miles away.)

In addition, with its location in the third poorest city in the state, much of the Natchitoches hospital’s patient population relies on Medicaid for coverage, but until the hospital opened its network of primary care and specialty clinics, few clinicians accepted patients insured by Medicaid.

Top chef One of Soileau’s first moves was to stem the out-migration of patients by setting up a physician group and recruiting specialists and primary care doctors who are employed by the hospital. He says he has lured specialists to Natchitoches, the oldest city in Louisiana, in part by selling them on the beauty of the place and in part by promising them plenty of independence to expand their practices.

“We interview lots of doctors and then we bring in a bunch and we don’t put a lot of offers out there,” Soileau says. “When we do I tell them the story like this: If you’re a chef and if you’re a chef that needs to follow a recipe and only likes to cook by a recipe, this is not the place for you because our cookbook is a blank slate and you tell us how to make it work.”

The hospital also developed what Soileau calls “strategic partnerships” with physicians to jointly own and operate specialty clinics. By 2020 it had set up eight joint ventures. Most of the ventures are with physicians with independent practices but a few are with doctors who have, subsequent to the ventures being set up, become employees of the medical center. “It’s been mutually beneficial not only to our medical staff but also for the community,” Soileau says of the physician partnerships.

Clinic network The ventures are part of a network of 17 clinics and facilities that are affiliated with the medical center. Over the summer, the hospital opened a 17,000-square-foot multispecialty clinic in its adjacent medical office building. The practice includes orthopedists, general surgeons, pulmonologists, urologists and ear, nose and throat doctors employed by the hospital. The setup reduces overhead as doctors share diagnos-

irk Soileau wants his leadership team at Natchitoches Regional Medical Center in Louisiana to mirror the community it serves in aspects such as race and gender. That was one of his motivations for starting a leadership institute for the hospital.

Employees who want to take part have to submit applications and references, undergo peer interviews and then be selected by senior leadership.

They also have to commit to staying with the organization for at least three years or agree to repay the cost of their leadership training.

Participants get all-day training one day a month for nine months from Human Dynamics, a leadership and human development company. They have to complete a capstone project that benefits the medical center by improving throughput or patient experience.

In its first year, 44 employees applied for the program. Fourteen were selected and graduated. “That’s our pipeline of emerging leaders,” Soileau says of the graduates.

Plans for a second class were slowed a bit by the pandemic but the application process got underway last fall. That group will go through the training this year.

To give his current leadership team time to bond and exchange ideas, he takes them somewhere off-site once a month. They spend the day talking about strategies for improving care.

“This is mission critical to what we do,” he says.

— LISA EISENHAUER

A clinician at the Pulmonary Associates clinic at Natchitoches Regional Medical Center in Louisiana tests a patient’s lung capacity. The venture is part of a network of 17 clinics and facilities that are affiliated with the medical center.

tic imaging and lab services in the building.

“We were able to take these six different physician practices, eliminate their labs, eliminate their office managers and everything that was duplicated in each clinic and we’ve consolidated them and made them much more efficient and much more cost effective to manage,” Soileau says. In addition, the clinic building is connected by tunnel to the hospital’s heating and air conditioning system, which had extra capacity and can meet the clinic’s needs at no additional cost.

This year, a closed-door pharmacy that is eligible to take part in the federal 340B discount program will open at the clinic. “It will mean a staggering difference in price that we can buy medication,” he says of the 340B program, which is open to patients seen within the hospital’s network. A project years in the making, Soileau says the outpatient pharmacy will give low-income patients access to affordable medications, as the 340B savings will be passed on to pharmacy customers. This is especially important to stabilize patients following hospital discharge and it is expected to reduce the hospital’s avoidable readmission rate.

such scale.

“We take on every opportunity to partner with CHRISTUS as best we can,” he says.

This includes working jointly in clinical services, oversight and compliance.

Money back guarantee Soileau is CHRISTUS Health’s advocacy officer for the state and he lobbies at the national level for favorable policies and funding.

When Louisiana expanded Medicaid under the Affordable Care Act in 2016, it helped cut the hospital’s bad debt almost in half, he says. However, because none of the independent primary care and internal medicine physicians in Natchitoches accepted adult Medicaid patients, the program’s patient population was using the medical center’s emergency room for nonemergency services and getting only episodic care. The state was spending $460 on average for every ER visit by an adult insured

by Medicaid.

Soileau told state officials that if they could help the hospital persuade the federal Centers for Medicare & Medicaid Services to change the designation on its walk-in clinic to rural health clinic status, so those adult patients with Medicaid coverage could be treated there, the state would spend $115 per visit. “I said I guarantee you that if we do not reduce our nonemergent visits in our ER, I’ll pay you back,” he recalls.

Soileau’s pitch worked. The status change took effect Jan. 1, 2019. The hospital set a goal of reducing nonemergency ER visits by at least 20% in three years and Soileau says it was closing in on that goal last fall.

He credits part of the success to the work of an ER nurse who follows up with highfrequency patients to ask if they have a primary care doctor. She encourages those who don’t to take advantage of the rural health clinic for primary care.

The nurse started working with the top 60 “multi-visit patients.” In less than two years, she has managed to steer all of those patients to the clinic and eliminate their nonemergency ER visits.

“We now provide primary care for this beneficiary group seven days a week, 12 hours a day,” Soileau says. “We have the only

clinic in the state that is open those hours. It has meant an amazing improvement in the health and wellness of these patients.”

Connecting with employers To bring in more patients, the hospital Value added contracts directly with large employers for Soileau is seeking a federal waiver for a urgent care. Employers pay a monthly fee trial program to charge patients insured by for a program called “Access Care.” With Medicaid a $5 copay for ER visits. He thinks that, their employees can use the hospital’s that token amount will be enough to spur urgent care clinic, which is open 12 hours a even more patients to use the clinic instead day, seven days a week. Access Care patients of the ER for primary care. are seen within 30 minutes and do not pay “What our ask to CMS is, is allow us a copay. The urgent care clinic is in the to do a 24-month demonstration project same building as the hospital’s primary care where we, by providing access to primary clinic. The primary care and urgent care care seven days a week, can show a reducclinics jointly log about 3,500 patient visits tion in Medicaid growth for nonemergent per month. care (in the ER),” he says. “We believe it’s a The city, with about 200 workers, was no-brainer.” the first to sign on to Access Care. More Last summer, his plan to launch a recently the parish, Alliance Compressors “Department of Innovation” got slowed and another large private employer, a group by the pandemic. Soileau hopes to have an of state workers and the hospital itself have innovation director in place and the departjoined. The program now covers about ment operational this year.

6,500 people and results in about 12% of the “All we’re focusing on is strategies to combined visits to the urgent care and priimprove the care of our communities,” he says. “How can we do it better, quicker, mary care clinics. faster, with less resources?”

“The sell to the employers was that we guarantee if you do this you will reduceHe says, “Be still, and know that I am God; I will be exalted among the nations, I will be exalted in the earth.” your medical spend for your associates.

So, if (employees) have a cough, we treat the cough before it becomes pneumonia and they have to be admitted to the hospital,” Soileau says, adding: “Every one of our employers to date have saved money year over year.”

For just this moment, bring your attention to your breath.

PAU S E . B R E AT H E . H E A L .

Be Still

The CHRISTUS Health advantage While the health system does not provide any direct funding to the medical center, Soileau says the hospital benefits in many other ways from its connection to CHRISTUS Health.

Soileau captured cost savings for the hospital by joining CHRISTUS Health’s group purchasing programs, something he says the hospital wasn’t aware it qualified to join until three years ago. “When we signed that agreement, without changing one single supply, we saved $1 million overnight,” he says. “That’s just because an organization the strength and size of CHRISTUS buys in

INHALE deeply and settle yourself into your body.

EXHALE the stress and tension you feel.

On your next inhale, pray, Be Still And as you exhale, And Know That You Are God Be Still And Know That You Are God KEEP BREATHING this prayer for a few moments.

(Repeat the prayer several times)

He says, “Be still, and know that I am God; I will be exalted among the nations, I will be exalted in the earth.” PSALM 46:10 © Catholic Health Association of the United States