Orlando Medical News June 2022 by Orlando Medical News

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The State of Healthcare Construction The pandemic set in motion radical changes in building and renovating hospitals, clinics and medical practices

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TBI Traumatic Brain Injury TBI

COVER STORY The State of Healthcare Construction

What Does Healthcare Construction Look Like in Orlando?

HEALTHCARE LEADER For Ohme Entin, Running A Hospital Is All About People

EOCC Ransomware Attacks – It CAN Happen to You

HIPAA Compliant Telehealth: How-To’s and Don’t Do’s

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The State o The pandemic set in motion radical changes in building and renovating hospitals, clinics and medical practices By LYNNE JETER

The 2020 pandemic set off a persistent chain reaction of challenges for the healthcare construction community, significantly altering the way hospitals and medical practices are being built and renovated. Birmingham-based Robins & Morton, a privately held construction firm, recently unveiled the study, The State of Healthcare Construction, which highlights market trends and shows how building and design team partners have responded to dramatic changes. “In many ways, the past year has been even more

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of Healthcare Construction in 2020, have put the industry in the lurch. disruptive than 2020, creating challenges that “Building these facilities so quickly everyone in every aspect of healthcare conshowed everyone the benefits of a comstruction will continue to face in the year mitted partnership and opened our ahead,” said Bill Morton, CEO of Robins eyes to questioning the status quo,” said & Morton. Patrick Duke, managing director of Dallas, The report’s findings underscore the Texas-based CBRE Healthcare. “That importance of a collaborative and integratexperience changed the notion of what was ed approach in addressing escalating costs, possible when everyone came to the table supply chain issues and labor shortages. The together to solve a daunting problem.” report reviews how the pandemic accelerated BILL MORTON The report points out three practical, time-sensichanges in traditional approaches to healthcare contive changes that have occurred to accommodate market struction, and how those best practice lessons are being fluctuations: applied to these challenges. The siloed approach in healthcare construction has diminished. Instead, scenario planning across disciplines Managing Volatile Construction during preconstruction is essential. Costs & Supply Chain Disruptions The ongoing level of material shortage and resulting Soaring construction costs, severe labor shortages, cost escalation requires changes in procurement strategy, chemical plant shutdowns, wildfires in timber forests and including the strong consideration of early purchasing a record-setting residential boom have greatly hindered advantages. healthcare construction projects. Because disruption and redirection caused by spiking Logistical and supply chain bottlenecks are coupled material pricing caught industry workers off-guard, it’s with the doubling in demand of materials and labor. For become more important than ever to communicate with example, the report points out that more than 1 million transparency. construction jobs remain unfilled across the nation. These “This recent shift requires a new mindset and includes challenges, combined with a record-breaking surge of the need to reset past practices,” said Kevin Harney, AIA, creating alternate care facilities to treat COVID patients vice president of New Jersey-based ESa Architects.

Moving Beyond Code with Resilient Building Envelopes More than a decade ago, a massive EF5 tornado destroyed St. John’s Regional Medical Center in Joplin, Mo., ripping off most of the building’s walls, windows, and roof system. Five patients died when ventilators lost electrical power. The consequences of this tragedy and related natural disaster losses led to recently adopted wind-load standards. This year, a new and emerging edition of the energy codes and standards require a higher level of thermal performance from the exterior envelope, including roofs, windows, and walls. “Hospital owners realize the cost and risk attached to doing long-term constant maintenance,” said Sam Burnette, AIA, principal at ESa’s Nashville, Tenn.-based design firm. “The lesson learned is that you can achieve a tremendous return on investment and a lower life cycle cost when you build with better quality exterior building envelopes.” Burnette has noticed a dramatic reduction in expense and patient disruption from repairing leaky glass to upgrading building exteriors to correct poor energy performance.

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The State of Healthcare Construction Parenthetically, noise mitigation is often an overlooked factor in building envelope decisions. “If the patient isn’t getting a restful night’s sleep or can’t nap following medical procedures or imaging visits during the day, they’re not likely to give the hospital a positive score on noise management,” Burnette noted. Key takeaways: Building envelope decisions extend far beyond today’s code requirements to include long-term opportunities for futureproofing hospitals. Early in the process, the options for building envelope components should be considered by an integrated team of designers, consultants, builders, and hospital facilities staff. A set of decisions with lasting impact on building resilience, patient and staff safety and service continuity for the hospital should be considered by the frequency and extent of natural disasters. The strategic choice to avoid the need for costly revision and rework years later should be supported by research, testing, and envelope mockups.

Increasing Trust-based Collaboration When BayCare Health Systems expedited the opening of multiple patient floors on a new, six-story tower at St. Joseph’s Hospital in Tampa, a host of players – the client, contractor, architect, engineer, trade contractors, vendors, city and state inspectors and city officials – forged new ways of collaboration. “The important thing is to have people who understand the why behind the project, those who know what we’re trying to accomplish,” said Larry Bagby, assistant vice president at AdventHealth Tampa. “It may be a little uncomfortable, but it’s so important to go outside your comfort zone and seek out learning that’s beyond your own day-to-day environment. People who do this on our projects develop a much better view of their client’s world.” For example, when the Carilion Roanoke Memorial Hospital’s 400,000-square-foot expansion was underway for The Crystal Spring Tower in Roanoke, Va., the vast team of players was extended to another level: including conversations with community residents. “These conversations revealed the real importance of the hospital expansion, and the opportunity to improve access to care for the entire Roanoke Valley community,” said Josh Farr, a superintendent at Robins & Morton, who implemented routine pre-business Tuesday morning team rallies that eventually included 600 people. “Those kinds of personal experiences open everybody’s eye and demonstrate the purpose of what we’re really here to do – not just build a hospital but help to take care of people for generations.” Duke said the pandemic experience of the past two years “makes the human side of the business more visible and important. Company leaders and our clients are more willing to question past methods and ask, ‘How do we do this better?’” Bagby suggests team members observe the function part of the project. “Talk to the forward-thinking nurse manager or the maintenance workers and ask them what they dream about to make their work easier,” he said. “When we find individuals who behave that way, everything else becomes easier to accomplish.”

What Does Healthcare Construction Look Like in Orlando? Even with the arrival of the COVID pandemic in the U.S. in 2020, population growth in and around Orlando continued but healthcare construction took a hit.

It's items like that, that we're finding new ways to help owners. I don't think owners hire us just to tell them that things are hard to find, and they're more expensive. They're looking for us to find how we can help as a partner to drive the project to completion.

To find out what’s going on in the area, Orlando Medical News talked with Jeff Butler, senior pre-construction manager with Robins & Morton, contractors who have $40 million of projects currently in construction to add to their total of $2.7 billion in the Central Florida healthcare market alone.

OMN: Overall what’s the general view of healthcare construction around Orlando now? Jeff Butler: I handle a lot of the projects in the state, so Orlando's very similar to a lot of the other cities like Tampa, Miami and Jacksonville and healthcare construction seems to be booming. I would say over the last year the influx of projects are not small renovations, but a lot of large renovation projects all throughout the city. From a healthcare perspective, this has been a big boom over the last six months to a year.

When the pandemic hit, did you get a lot of cancellations on projects that had not yet begun? JB: We did. I don't know if we had any major pauses. Some of our projects were doing renovations and had to pause for a week or so to make sure they were following or have in place the correct protocols. A lot of projects that were in the planning process had paused, and I think that's what we've seen in late 2020, 2021 and 2022, those projects that were on pause are now starting up and actually under construction on top of the ones that were planned to be built in this timeframe. It's almost like two year’s-worth of projects that were on the planning phase being done in a year's timeframe.

Now that projects are in construction again, can you share what challenges you're facing with projects in Orlando? JB: It's supplies and material, it's the cost. Vendors and material suppliers are dealing with issues such as escalation of gas prices and availability, and now we're seeing things that we've never seen before. For example, I was talking to a contractor who said that they were waiting on an air handler that was shipped out for a project, and the manufacturer is wanting an increase in cost. That's never happened. Usually once you do a PO and you go under contract that (price) is locked in, and it's just down the line as far as, shipping costs, material costs and material availability. We really struggle, especially on the construction side...one is maintaining the budget, and the other is trying to get material on time. Things that were taking X number of weeks, now, it's almost times two. We've had to shift our focus to plan early, and then to educate our owners on projects that might be six months. But they might have, let's say, a generator as part of that six months project but it might take a year to get certain electrical gear for that generator. So, now you're planning something for only a six-month project a year in advance.

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Can you tell me the approximate value of healthcare construction projects around Orlando now? JB: On a Greenfield new hospital, it ranges from $600 to $700 a square foot. Not every project is the same. Sometimes the health systems might build say a five-story building, but they are only going to build out four of the floors to have infrastructure ready for future growth. On the renovation side, it all depends on the type program that we renovate - an OR might be as much as $800 to $900 a square foot or an admin suite might be $200 a square foot. It all depends on the program; is it a complete gut and redo with multiple phases, or is it just a light refresh?

Are there any specialty elements to projects? JB: I think one of the trends that seems to be talked about in new facilities, is in the event of something like COVID occurring. We might have a whole floor as a pandemic unit that has the mechanical system to be able to handle something like that again.

What short-term trends do you see, large hospital projects or urgent care and specialty clinics? JB: I would say three years ago we saw a big influx of freestanding EDs. Both of the major health systems, Orlando Health and AdventHealth were doing a lot of them in and around the Central Florida area. We haven't seen those as much. We have slowly started to see new smaller hospitals down in South Florida and the trend is usually for new types of projects to go up the Turnpike. These are developer-driven hospitals that might not have an emergency department but are more like ambulatory surgery centers. Some of the health systems are doing larger hospitals with the certificate of need going away. That's where we are seeing the biggest reason for this boom. Once that CON started to go away, and it was a tiered approach, that's where we've seen the different health systems around Central Florida start major growth with larger projects. We have seen medical office buildings increase but they ebb and flow. One year we might see one or two, the next year we might see a lot more of them.

In the next 10 years what outlook do you have for the market? JB: I would love to say it's going to keep on this trajectory, but I think, at some point it will level off. There are still people moving to Central Florida and expanding what is Central Florida. Out in the Clermont area, and I grew up here, we didn’t see that as part of Orlando, but now it is. I do think construction is going to continue to grow, just because of the amount of people that are moving here, whether it's people retiring here or moving here from other parts of country. I think there was such a lack of construction in 2020 that we're still trying to make up for.

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For Ohme Entin, Running A Hospital Is All About People Running a hospital has got to be one of the most complex jobs you can have.

get a gift for his wife. Staff members were able to get a card and some flowers and decorations for the room to surprise his wife when she came to visit later that day. “He was able to give her the flowers and they were able to celebrate their anniversary in spite of his being in the hospital,” said Entin. “It made it really special. Those sorts of things don’t happen unless the team feels supported and is able to pay attention to the little things.” Members of the community are taking notice. One family just dropped off a batch of frosted cupcakes, each with a letter that spelled out “Orlando Health Team Is the Best.” This is no accident. Since St. Cloud Hospital became part of the Orlando Health system in July 2020, there has been a relentless focus on improving the level of care the hospital provides to St. Cloud residents and the wider Osceola County community. “We have already crossed several important milestones at Orlando Health St. Cloud Hospital. And for 2022, we eagerly anticipate even more,” Entin added. “For example, we strengthened our intensive care unit (ICU) by adding our tele-intensivist program. An intensivist is a physician who specializes in the care of critically ill patients, most often in the ICU. We have the tele-intensivists 24-7, providing patients with aroundthe-clock intense treatment, close monitoring, and patient-focused care. We also have a nurse practitioner seven days a week in the ICU. We’ve also brought onboard our first dedicated chief quality officer (CQO) to lead and implement strategic plans for quality improvement and regulatory compliance. Having a CQO is an Orlando Health standard, and we were excited to add this role to our hospital and have already benefited tremendously,” Entin added. As part of the campus master plan, the hospital is physically expanding to meet the growing needs of the community. In the months ahead, it will break ground

In addition to the normal management challenges any business or organization faces, you must include an intricate array of government regulations, health insurance processes, perplexing finances, and emerging technologies, medicines, and medical procedures. And to top it off, doctors and your employees – the nurses, frontline and administrative personnel, and other professionals – are often caring for people on some of the worst days of their lives, when they need treatment for a serious injury or illness. Knowing this, you can guess that the sort of person drawn to this role must be smart, focused, energetic and a strong leader. Meet Ohme Entin. She’s the president of Orlando Health St. Cloud Hospital. “I was always interested in healthcare,” Entin said. “My mom was a nurse, so I was around nurses and healthcare professionals my entire life. But I didn’t know I wanted to do healthcare administration until I took a class at Rutgers University. My professor, Stephen Jones, was the COO of Robert Wood Johnson University Hospital, and had great energy and great passion for the subject.” “One day, I just asked him, ‘How do I get your job?’” Entin laughs at how naive she was. He encouraged her to get as much practical experience inside a hospital as possible before she committed to a career. She ended up working in a hospital as a unit secretary and completing an internship in hospital administration while she went to school. “That’s when I fell in love with operations and knew I wanted to be a hospital administrator.” That day came in November of 2020, when Entin took on the role of president of Orlando Health St. Cloud Hospital, just a few months after Orlando Health acquired the vulnerable pillar of the St. Cloud community. She hit the ground running. “There are so many facets to healthcare, you have to focus on the piece that resonates with you the most,” she said. “For me, it really comes back to the leadership of people. Knowing that I am not a clinician, but I still want to be as close to the care we are providing as possible. So, what I love about this role is that I get to care for the team that cares for our patients.” A big part of Entin’s role then is to create a supportive and collegial environment for everyone who is part of a patient’s care. That team is not just the doctors and nurses, but also the people behind-the-scenes, such as those who work in the labs, are part of the supply chain, or who work in environmental services. “This means being able to be on the frontline myself and seeing all the barriers or challenges that one could face in order to take care of a patient and being in a position to make a change that helps the whole team.” That kind support for her team can lead to unexpected benefits for patients. Recently, while the guest services team was doing rounds – visiting each of the patients in the hospital – one man seemed especially sad. The team found out it was the man’s 20th wedding anniversary, and because he was unexpectedly in the hospital, he hadn’t been able to

on a new two-story building that will open in 2023. This will provide a new ICU, two catheter labs, and a new cardiology suite. And then later this year, it’s expected to open the new Orlando Health Cancer Institute – St. Cloud. This will be the organization’s fifth regional facility, and it will offer patients world-class cancer care options they’ve come to expect from Orlando Health in a space that is closer to home. “I moved to Orlando from Texas in 2018 with my family,” Entin continued, “and it was the best move we ever made.” First serving as the chief operating officer at Orlando Health Dr. P. Philips Hospital in Orlando’s busy tourism corridor, Entin was promoted to president of Orlando Health St. Cloud Hospital two years later. She and her husband Hindolo and their two daughters, Zaria-Grace and Nova Joy, are now St. Cloud residents and loving it. “We are very proud to call St. Cloud home and to be in this community,” she said. “It’s just full of great leaders, and even though it’s growing, it has a great hometown feel. It’s somewhere where you can get to know your neighbors, which is pretty nice. And for me this hospital is more than a job, it’s personal. We live here and this is the hospital that will care for me and my family if we need it.”

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CALENDAR: Coffee Club East: Often imitated, never duplicated…the ORIGINAL Coffee Club PTSD Awareness Discussion THURSDAY, JUNE 2 | 8:30 – 9:30 AM FREE to EOCC Members | $10 for Non-Members

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Ransomware Attacks It CAN Happen to You DOROTHY HARDEE, CHAMBER ADMINISTRATOR

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“Ransomware is unique among cybercrime because in order for the attack to be successful, it requires the victim to become a willing accomplice after the fact” – James Scott, Senior Fellow, Institute for Critical Infrastructure Technology

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OPTIC Orlando: Ransomware – The New Weapon in Cyber

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EOCC Real Estate Advisory Council Planning Meeting

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EOCC Nonprofit Roundtable

In January, a Florida panhandle hospital system escaped a crisis-level hack by shutting down their entire records system causing hospital staff including nurses and doctors to resort to pen and paper for days. Kronos Workforce Central announced they finally restored their system after an attack left them unable to keep track of timekeeping for clients’ employers allowing them to properly pay their employees. In February, the San Francisco 49ers confirmed they were a victim of ransomware, discovering the company listed on the dark web leak site. Hackers used BlackByte, a ransomware-as-a-service software stealing company financial data. That same month Nvidia, the world’s largest semiconductor chip company confirmed the hack by Lapsus$, a self-proclaimed, non-politically affiliated group, stealing employee credentials and proprietary information. One month later Lapsus$ struck again hitting mega-corporation Microsoft, stealing 37GB of Microsoft’s source code from its Azure DevOps server, releasing it on the dark web. What does the rest of the year hold for cybercriminals and the chaos they are causing? Experts in the field expect it to ramp up. Nick Rossman, global threat lead for IBM-X-Force expects to see more and more “triple extortion ransomware.” A ransom attack on one business can become an extortion threat for its business partner. You can only imagine the problems that would arise if your system were held hostage, but also if one of your suppliers is affected as a result. Now the attacker comes to you knowing you cannot afford disruption in the supply chain. Taking this one step further, imagine your partner(s) was targeted because your systems were not protected against a breach? Do not think it is just computers that are hit. Printers and copiers are overlooked but can be equally vulnerable whether a corporate machine or a home copier for individual use. Edward Segal, senior contributor to Forbes predicts the ride

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Ribbon Cutting: Physical Therapy Now THURSDAY, JUNE 23 | 5:30 – 7:30 PM Physical Therapy Now

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EOC Foundation Planning Meeting TUESDAY, JUNE 28 | 9:00 – 10:30 AM East Orlando Chamber of Commerce

EOCC Real Estate Advisory Council Breakfast “Emerging Commercial Development Trends 2022” WEDNESDAY, JUNE 29 | 8:00 – 9:30 AM $35 EOCC Members | $40 Non-members

Visit EOCC.org for a complete listing of June events

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to get even bumpier as cybercriminals hone their craft. In his article “8 Crystal Ball Predictions About Cyberattacks in 2022” he identifies the following possible scenarios: • The supply chain of a major vaccine manufacturer to be halted by ransomware • Extortion of Olympic athletes during the Beijing Olympics by following email exchanges • Cyberthreats are expected to evolve elevating fears • The weaponization of malware to dynamically change code taking advantage of existing vulnerabilities • More triple extortion ransomware forcing businesses to scrutinize and audit their supply chain’s access to their data, security, and policy controls • The impersonation of C-level executives making socially engineered frauds more believable • Exploitation of remote servers and services brute forcing them due to their “inefficient hardening practices” • Nation-State attacks crippling an already stressed supply chain, significantly affecting the economy Last month Verizon’s annual security breach reported ransomware continues to be a fast-growing threat with the “human element” playing a significant role in 82 percent of security breaches. According to the U.S. carrier’s 2022 Data Breach Investigations Report, ransomware outbreaks increased 13 percent year-over-year, seeing the biggest jump in five years. Rick Holland, CISO and VP of strategy at Digital Shadows told The Register that “stolen credentials, phishing, and vulnerabilities” are the top ways in which threat actors gain access to organizations. Despite spending billions of dollars defending the environment, problems persist. John Gunn, CEO of Token, an authentication specialist, echoes the reason for more than 80 percent of breaches is the human element. He recommends implementing “more authentication and going passwordless. Biometric and wearable authentication is more secure, convenient” and “mitigates massive cybersecurity vulnerability” almost instantly. Lisa Sotto, partner and head of global privacy and cybersecurity at Hunton Andrews Kurth said, “Every company, regardless of industry sector, will need to be laser-focused on strengthening their security measures.” According to the FBI’s Internet Crime Complaint Center, there is an increase in ransomware and small business is an increasing target, especially since small businesses may serve as their own IT specialists. The latest information showed that there was a 20 percent increase of incidents between 2019 and 2020, while the financial demands per incident increased by 225 percent. Gary Brickhouse, CISO with GuidePoint Security suggests that small business needs to “understand what the attack is, contain it and make sure it doesn’t get worse and how to restore” your business. And what about the people behind the crime? Jack Rysider (Darknet Diaries) shares an episode exploring one cybercriminal who took social engineering and ransomware to a whole new level starting his path into the dark side of technology at only seventeen. On June 10th from 9:00 – 10:00 AM, Avani Desai, CEO of Schellman will lead a discussion with experts in the field exploring “Ransomware: The New Weapon in Cyber”, presented by the East Orlando Chamber and hosted by Full Sail University. Among the panelist are Angela Polania, Principal at Elevate a premier consulting firm specializing in Cyber Security, IT Compliance and Privacy; Chet Naran, Director of IT at The Villages Health System, LLC. and Daniel Poloche, VP of IT and Security at Stax. Digital technology is growing rapidly, and ransomware gangs and their methods are advancing at an aggressive rate. The loss for innocent people is more than $49 million. Regardless of your industry or the size of your business, there is no one immune to an attack. Register today at eocc.org. This program is open to all and a budget friendly $10 per person. For more information or to register for events call (407) 277-5951 or visit our website at eocc.org. The East Orlando Chamber of Commerce everywhere East of I-4.

HIPAA Compliant Telehealth: How-To’s and Don’t Do’s refresher. Under HIPAA, healthcare providers and insurance companies are considered covered entities. They are responsible for creating and using patient PHI for treatment, billing, and diagnosis. If electronic protected health information (ePHI) is transferred to another company for purposes such as storage, scheduling, or telehealth, those companies are considered business associates.

BY TERRY MCFARLAND

In the midst of all the chaos caused by the COVID-19 pandemic, one bright spot is the increased availability of HIPAA compliant telehealth options. Quarantines and travel restrictions created a need for patients to be able to access health care remotely. The Department of Health and Human Services (HHS) has scaled down HIPAA enforcement as it relates to telehealth, but that won’t always be the case. What should you do now to ensure that you are offering HIPAA compliant telehealth services?

• If a business associate is HIPAA Compliant, they understand that a Business Associate Agreement (BAA) must be signed before any ePHI is transmitted. Failure to do so is a violation of HIPAA. A BAA should specifically address how ePHI is to be protected and the responsibilities of both parties.

HIPAA Compliant Telehealth: HHS Giveth, but When Will They Take Away?

• They have a secure and compliant cloud service with data encryption. Your telehealth partner must be able to securely store and protect your ePHI. Their network and services must meet all of the requirements of the HIPAA Security Rule.

On March 15, 2020, U.S. states began shutting down in response to COVID-19. The Centers for Disease Control (CDC) reported a 154 percent increase in telehealth services during the last week of March 2020 over March 2019. As providers worked to provide quality telehealth care for patients during the shutdown, new options had to be considered, some of which had a steep learning curve. In recognition of the need, HHS issued guidance stating, “Covered health care providers will not be subject to penalties for violations of the HIPAA Privacy, Security, and Breach Notification Rules that occur in the good faith provision of telehealth during the COVID-19 nationwide public health emergency.” When the public health emergency is rescinded, normal enforcement of HIPAA rules and regulations is expected to return. Earlier this year, the American Medical Association sent a letter to the Director of HHS’s Office for Civil Rights (OCR), asking for a “one-year glide path to compliance, during which physicians and other affected parties shall not be subject to HIPAA audits and other HIPAA enforcement activity related to telemedicine.”

• They have strong access controls or can effectively implement access control measures. Access controls help fulfill the requirements of the HIPAA Privacy Rule and the Security Rule by limiting access of information to only authorized individuals. • They conduct periodic risk assessments and self-audits as appropriate. A HIPAA compliant

HIPAA Compliant Telehealth Platforms: The Non-Negotiables While we wait for OCR’s response to the request, there are things that providers and business associates should do now to eliminate potential violations. The overarching principle should be to base any decisions regarding telehealth service platforms or apps on the same criteria you would any other vendor with whom you work.

Here are five must-haves for HIPAA compliant telehealth platforms: • The telehealth service, platform, or app should be HIPAA compliant. That means they have gone through the same type of process to achieve HIPAA compliance that you have, including Security Risk Assessments, effective policies, procedures, and training for their employees, and all of the other requirements of the law. • Most companies who are HIPAA compliant will proudly state that somewhere on their website or in their marketing materials because it differentiates them from their competitors and tells potential partners that they are committed to safeguarding the protected health information (PHI) entrusted to them. • They are willing to sign a Business Associate Agreement (BAA). Here’s a quick HIPAA 101

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telehealth platform or application will be able to track and audit the processing, transmission, storage, and proper disposal of ePHI that they possess. At a minimum, assessments and self-audits should be conducted annually. A good rule of thumb is that the more data that is being stored by the telehealth app or platform, the more often self-audits should be conducted. Self-audits should also include scanning for unusual activity on the network. This can assist with preparing an effective response to a cyberattack or breach incident.

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Tailored Wellness: Making the Most Out of a Broken System BY JOSHUA WASHINGTON

in the exam room – a positive request. However, after meeting with the doctor and listening to their personal and practical needs, I quickly realize that while the challenge is indeed communication, for the physician, the communication challenge wasn’t with the patient but rather communicating better with their team. I would have targeted the wrong source. Scenarios such as this present some of the drawbacks by well-intended initiatives meant to help doctors, instead these initiatives cause more frustration or worse, waste of valuable resources. Nothing promotes healing and wellbeing, provides greater clarity, or accelerates performance improvement like connecting with and understanding the needs of the individual.

"I was finally able to complete a full run. I haven't been able to do that in quite some time due to the noise (in my mind). Previously I would just stop running, now I can finally finish again." These were the words from one of my physician clients. As an organizational psychologist my world is communication coaching, however, due to the nature of the beast known as burnout, physician communication coaching sessions easily evolve into a focus on the stress and challenges at the personal and practical level, venturing beyond needs such as assistance with enhancing communication skills. Sessions like these reveal the importance of providing support for caregivers individually with a tailored approach. A tailored approach to wellness takes into account the mental, systematic, and interpersonal factors of physician wellbeing, rather than just the symptoms. Physicians must be resourced with tools, skills, techniques, and individualized support that helps navigate the challenging factors faced daily, while also helping to lower stress, re-energize their work, and ultimately make the most out of a broken system. This emphasis is key to overcoming the growing epidemic of burnout among caregivers but should not replace efforts that are already in place.

Focus on physician centered care Increasing physician wellness requires a physician centered focus. For example, there are usually three important sources of communication that serve as the nucleus for a great work environment. These three areas are skills, systems, and staff. Skills represent the individual ability, systems represent the technical support, process, and operational functions that drive efficiency, and staff represents care team coordination and inter-departmental collaboration. Much of the focus around these three elements though usually concentrate on the patient in healthcare. Do we possess a high level of skilled individuals to care for the patient, are the systems functioning at peak levels creating a seamless experience for the patient, and does our team work well together in coordinating care for the patient? None of these focal points are wrong, however, when it comes to physician wellness, the focus must be on the physician. We must ask questions such as:

Nothing beats the local level Our efforts are most impactful at the individual (local) level with strategic and diligent focus on identifying what wellbeing looks like for each physician. While many physicians may demonstrate the same symptoms, the cause of their challenges often differ. Frequently, I’ve witnessed businesses approach human challenges with a broad-brush strategy. Why would many organizations do this you ask? The answer is that humans are complex, which makes providing care tailored to the individual physician challenging. Consider the topic of communication for instance. I’ve been asked to help doctors enhance their communication

• How does the physician’s current skill level promote wellbeing (as a leader, communicator, and competent clinician)? • How do the systems around the physician promote wellness or lack thereof (scheduling, operational demands, constraints, and responsiveness)?

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• Finally, how does the team’s coordination and collaboration promote overall wellness for the physician (think staff training, job competency, team communication, conflict resolution, talent management, etc.)? We should concentrate our focus on the balance of patient and physician care.

Identify the source, then target the source Identifying the source allows for a more targeted conversation with the physician and will help uncover leading causes of burnout and poor performance. The administrator that requested I meet with this physician wasn’t aware that there are seven potential sources of communication that can cause poor performance and/or burnout. See list below for a primer on potential sources.

• Administrative - Physician Communication • Scheduling - Access communication • Physician - Clinical Team Communication • Physician - Manager Communication • Manager - Team Communication • Team - Interdepartmental Communication • Team - Patient Communication It’s vital that we listen to the physician’s individual pain-points, then act on those points by developing resources and solutions.

Remember, physicians are in the business of relationships Picture this. You are tasked with floating from one small room to the next every 15 minutes where you are expected to connect with each person at the relational level (personal), while also caring for their medical needs (practical). If that doesn't seem daunting enough, throw in RVU’s that measure how many of these relationships you can manage to serve per day, while Value Based Care judges the quality of each interaction. This is a difficult task for an expert communicator, much less professionals who sparingly trained on highly effective communication techniques. These are the battles many of our doctor’s face daily. Doctors are not only in the business of medicine, but more importantly, in the business of relationships. A physician's ability to manage relationships has always been an important indicator of success and wellness. Earlier I mentioned how many organizations struggle to focus on providing care tailored to the personal and practical needs of the physician but when you think about it, that’s exactly what physicians are expected to provide every single day for their patients and team? For this reason, I believe it is essential that physicians have access to the same individualized care they are expected to provide both personally and practically. We must ensure that doctors are developed and equipped properly by focusing on the needs of each individual physician, providing a tailored approach to wellness. Joshua Washington is an organizational psychologist and expert communicator who specializes in personalized coaching and training. Physician well-being, communication within healthcare teams, and talent management are a few of his most common focus areas. Joshua’s goal is to help reduce workplace stress and burnout for caregivers and teams by applying scientific principles of human behavior. Visit www.LeeMalveaux.com to learn more, or contact joshua@leemalveaux.com

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Pandemic Socialization Reintegration Anxiety BY MARY-CATHERINE SEGOTA, PSYD

COVID-related stressors and socialization reintegration difficulties. Ask about the following stressors: financial problems (difficulty paying bills, debt), work problems (unemployment, decreased hours/roles, conflicts with colleagues, educational problems (difficulty completing course work), housing problems (instability, moves), relationship problems (isolation, separation or divorce, conflict with family or friends, intimacy problems), personal or loved one's health problems (new or worsening illness, medication issues, disability), and caregiving problems (emotional stress, time demands). Ask about mood and adjustment to changes, sleep, energy, appetite, and desires for activities outside the home. Ask about attempts to increase activities outside the house or avoidance of those activities. Consider the diagnoses if you suspect that your patient may be experiencing anxiety related to socialization reintegration. Agoraphobia typically lasts six months or longer and is accompanied by symptoms characteristic of panic disorder. These physical symptoms develop with the real or imagined exposure to the trigger (i.e., the fear of being in situations or places from which escape would be difficult or embarrassing in the event of a panic attack) and thus cause the patient to avoid the trigger (i.e., crowds, cars, buses, trains, and elevators). Most people with Agoraphobia fear leaving the house alone and can better cope with a trusted companion. Avoiding the trigger and subsequent symptoms can disrupt a person's social life, work, education, and daily functioning. The physical symptoms and signs are characterized by:

Individual reactions to the pandemic have differed in many ways. The initial adjustment to the shock of sudden and necessary lockdown and dealing with such issues as virus contagion, contamination fears, distance from loved ones, changes in patterns and routines, and isolation was difficult for almost everyone. Adding to this was the unanticipated extension of the pandemic spanning two-plus years, which led to additional difficulties adjusting and more distress. Now that we are beginning to return to integrated social interactions and a "new normal," we see that some individuals have not adjusted as well as anticipated nor resumed their prior level of functioning. What does this mean for healthcare providers, and how does it influence how we screen and probe for psychiatric issues? The pandemic has led to a widespread increase in life stressors experienced by many. These stressors can be social (restriction in face-to-face interactions) or occupational (unemployment, furlough, reduced hours, working from home). They can also be educational (changed schedules, remote studying) or health-related (having had COVID personally, having a loved one battle or succumb to COVID symptoms or exacerbations in underlying medical conditions due to COVID complications). Research has indicated that cumulative stressful events greatly affect an individual's physical health, inflammation, immune system functioning, and psychological well-being (Mohd 2008). While many individuals had difficulty adjusting to the social isolation and necessary daily activity changes at the beginning of the pandemic, others are having difficulty adjusting to returning to a socially integrated life outside the home. Further, some individuals are experiencing psychological distress that extends beyond that of 'difficulty adjusting.' When the world is dealing with many of the same issues (such as isolation during the beginning phases of the pandemic and nervousness returning to the workplace), it may be difficult for patients to understand and assess their symptoms, writing off their experiences as "everyone is feeling this." It is common for healthcare providers (and patients) to make certain assumptions about what is or is not due to experiences related to the pandemic. As one would expect, initial anxiety related to the pandemic was associated with Obsessive Compulsive Disorder (due to initial recommendations of hand coverings and cleaning of objects), as well as Health Related Anxieties (due to fears of contracting COVID, or difficulty differentiating COVID symptoms from other illness symptoms). An increase in anxiety during the pandemic led to fears of leaving the house for some and eventually symptoms of Agoraphobia, and Panic disorder. While not a DSM V diagnosis, some researchers have coined the term Coronaphobia to describe the excessive fear of contracting the virus and the stress and avoidance of public places and situations that result from that fear (Arora et al. 2020). As we transition to this new phase of the pandemic, it is essential to ask critical questions to help assess the presence of clinical anxiety and help differentiate disorders. For example, Is the patient's response in line with their current situation? Are family members concerned about the patient's level of anxiety and avoidance? Is the patient following current CDC guidelines, or are they avoiding more people/situations than needed? Another component is assessing the length of time the patient has been dealing with the symptoms. Self-reflection may be difficult and using anchors in questioning may help provide some insight. For example: "When did you first notice the symptoms? What was going on in your life (or the world) at that time? What was happening when you noticed the symptoms were getting worse?" Another component is helping the patient identify their underlying thoughts, beliefs, and fears that are experienced when they report these mood symptoms. Journaling with given prompts is a great way to help the patient record the necessary data to assess the level of severity and help differentiate between the diagnoses. Consider implementing a questionnaire that assesses

• • • • • • • • • • • • •

Chest pain or pressure Rapid heart rate Shakiness Hyperventilation Difficulty breathing Lightheadedness or dizziness Sudden chills or flushing Excessive sweating Feeling of choking Numbness or tingling Upset stomach or diarrhea Feeling a loss of control Fear of dying.

Listen to the patient's report regarding fear of leaving the house. Is the fear of contamination and illness? Panic or dying? Fears of criticism or rejection? In doing this, it is crucial to differentiate the symptoms of Agoraphobia with those of social anxiety.

Agoraphobia • Fear of leaving the house • Fear of having a panic attack in public places • Fear of being in situations where escape might be difficult, or that help would not be available if things go wrong • Feel better with a trusted companion • Social Anxiety Disorder • Fear of public places • Fear of situations where scrutiny by others may occur • Fear of being in a position of being negatively judged • Feel worse with trusted companion due to fear of scrutiny Yes, you can have both! Research suggests these disorders occur together approximately 68 percent of the time (Magee et al., 1996). Many people experience social anxiety symptoms for the first time when they begin to reemerge after months of social distancing or limited socializing. Reintegration became much more difficult for those who suffered from social phobias before the pandemic. What to do if your patient has anxiety related to social reintegration? For many, the anxiety experienced due to the pandemic is temporary. It should gradually improve as they become more accustomed to being out in the world and coping with changing COVID restrictions. Encourage good self-care, limit news, and social media exposure, and set boundaries to maintain healthy interactions. For those with more severe symptoms, referring for Cognitive Behavioral Therapy (CBT) is critical. CBT helps people recognize their thought patterns and gain skills for tolerating and managing difficult emotions, like fear of leaving the house. Combined with relaxation and desensitization techniques, CBT gradually exposes patients to anxiety-producing situations to learn how to overcome Agoraphobia. Treatment will also include addressing underlying issues, compounded stressors experienced in the pandemic, any loss of personal or familial physical health, and improving self-awareness, healthy coping skills, and independence. Partnering with a licensed mental health professional will help your patient better manage their symptomology and improve treatment outcomes. With a doctorate in clinical psychology and over 20 years of experience in the field, Dr. Mary-Catherine Segota has conducted university-based behavioral medicine research, acted as a consultant to professionals and organizations, and worked with a diverse number of psychological and medical conditions. By identifying unique needs, the source of distress, and what’s perpetuating the problem, she will help develop the tools to overcome seemingly insurmountable circumstances. Visit www.CounselingResourceServices.com

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It’s Okay Not to Feel Okay: Kids and Mental Health BY CORRIE KINDYL, PHD, LMHC, LMFT, NCC, ACS

opportunities to have fun – can counteract the effect of ACEs on adult health. Whether you’re a parent, relative, teacher or caregiver, you can help create that positive environment for the young people in your life by adopting a few simple habits:

From economic instability to at-home isolation, the COVID-19 pandemic took a heavy toll on America’s collective mental health. But for children and young adults, a steady rise in mental illnesses like anxiety and depression has been in the works for much longer. In a trend so marked that The New York Times dubbed it the “Inner Pandemic,” incidences of depressive episodes in adolescents rose 60 percent from 2007 to 2019. Similar sharp increases were observed for mood disorders, selfharm and even visits to the emergency room caused by mental illness. Right now, it’s estimated that more than 1 in 5 children under 15 has a mental health disorder that impacts their ability to function. Talking about mental health in children can be frightening. If you’re a caregiver for a child living with trauma, you may know that helping them heal is just as challenging. But that’s exactly why this past month – as National Mental Health Awareness Month and Trauma Awareness Month – is the perfect time to start those difficult conversations. It’s no exaggeration to say that supporting emotional and mental health at a young age is just as essential as making sure kids get regular check-ups at the doctor and dentist. In a landmark study in 1997, researchers from Kaiser and the CDC found that the more “adverse childhood experiences” (ACES) a child experienced, the higher their risk of illness and injury later in life. But there’s good news, too. Over the last few years, new research has also found that children exposed to positive childhood experiences – such as caring teachers, predictable and safe home environments, positive friendships and

• Change the Way You Listen. When kids are feeling big emotions, they don’t always have the words to express how they feel. Instead, you may see the symptoms before the cause: outbursts of bad behavior, poor focus in class, nightmares, changes in appetite or even self-isolation. Try to “listen” to what these nonverbal actions are really trying to express. • What’s the real trigger, or root cause, of their emotions? Are they dealing with conflict at home or at school? Adjusting to a new environment? Coping with the loss of a loved one? Or healing from previous abuse or trauma? Even something as “normal” as puberty and teenage hormones can be emotionally stressful. • Of course, there should be consequences for bad behavior – but that isn’t the same thing as punishing a child for feeling bad. Remember that you are your child’s model for patience, empathy and honesty – so make sure you practice those traits when you talk to them. Most of all, listen to your child’s voice and let them be part of the solution. • Teach (and Practice) Emotional Awareness. A child who feels “bad” may not know if they’re angry, scared, sad, tense, frustrated or disappointed. They may also not know how to distinguish between feelings (like sadness or fear); sensations (like fatigue or hunger); thoughts (like “I’m not good

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enough” or “I always mess up”); and actions (like shouting, hitting or crying). • That’s why it’s the job of adults to help teach them the words and skills they need to share, understand, and manage their emotions. Practice on-the-spot calming techniques, like counting to ten or taking deep breaths; or encourage activities (like art, sports, gardening or journaling) that build empathy and emotional control. As with any good behavior, try to “catch them doing good” and give them lots of praise when they do. • Cultivate Happiness. It’s natural to focus on the struggles associated with mental health but recognizing good and positive emotions is just as important. By learning to cultivate happiness, kids can create an emotional anchor that makes them more resilient to short-term setbacks and helps them find their own sense of purpose and joy throughout life. Helping any loved one manage mental health issues can be a heavy responsibility, but it’s not one you need to carry alone. Talking to your child’s pediatrician about their mental health, and asking for a referral to a trained therapist, counselor, or psychiatrist if needed, is more than “okay” – it’s the right thing to do. At Embrace Families, we’re working to build stronger families and safer homes in Central Florida and ensuring that all children have the support and validation they need to grow, heal, and achieve. To find out how you can be a part of that mission, visit www.EmbraceFamilies.org. Corrie Kindyl, PhD is a Licensed Mental Health Counselor, CEO of Community Counseling Center of Central Florida, and a member of the board of directors for Embrace Families Community Based Care.

Alzheimer’s Prevention:

Lifestyle Changes You Can Make for Better Brain Health BY BEAU HERMAN

Diet

Just as we have found ways to reduce heart disease risk, researchers increasingly are finding evidence that there may be steps we can take to reduce our risk of Alzheimer’s—or at least delay its onset.

Studies to date suggest that keto (low carb) and Mediterranean diets may be beneficial to brain health. Current studies suggests that heart-healthy eating may also help protect the brain. Heart-healthy eating includes limiting the intake of sugar and saturated fats and making sure to eat plenty of fruits, vegetables, and whole grains. Two diets that have been studied and may be beneficial to lowering the risk of Alzheimer's are the DASH (Dietary Approaches to Stop Hypertension) diet and the Mediterranean diet. The DASH diet emphasizes vegetables, fruits, fat-free or low-fat dairy products, whole grains, fish, poultry, beans, seeds, nuts and vegetable oils. The DASH diet limits sodium, sweets, sugary beverages and red meats. A Mediterranean diet includes relatively little red meat. It emphasizes whole grains, fruits and vegetables, fish and shellfish, and healthy fats like nuts and olive oil.

Evidence is strong that people can prevent or reduce their risk of cognitive decline by making key lifestyle changes, including regular physical activity, staying socially engaged, and maintaining good heart health. This combination with a focus on early detection can have significant results.

Lifestyle Changes for Brain Health There are steps that you can take to prevent or reverse mild cognitive impairment and improve cognitive function, performance, and brain health throughout your lifetime. Try these for reducing Alzheimer’s risk:

Mental Exercise There is evidence that mental challenges can produce a change in brain structure and greater resistance to aging processes at the cellular level. Keeping mentally challenged can mean crosswords, number puzzles, meeting a new person, going to a different park, reading a new book—there are many ways to challenge your mind.

Exercise Regular physical exercise has been shown to lower the risk of Alzheimer's and vascular dementia. Exercise may directly benefit brain cells by increasing blood and oxygen flow in the brain and has cardiovascular benefits. A medically approved exercise program is a valuable part of any overall wellness plan. If you exercise now, try increasing the intensity of what you do. No age is too old to start.

Adequate, high-quality sleep Poor sleep increases stroke risk in the brain, which is linked with Alzheimer’s. However, you can control many causes of poor sleep: caffeine, alcohol consumption, being

too active before bedtime, and mobile devices, whose blue light disrupts sleep.

Managing stress Uncontrolled stress keeps cortisol levels high. In the brain, cortisol can affect your memory. Along with other stress management techniques, consider mindfulness meditation, which quiets and slows the mind, helping you think more clearly and creatively. Start small, a few minutes a day. There are many good smartphone apps to help you get started. For better brain health now and later in life, identifying things you can change now and taking steps to protect your brain. That way, after age 65, when cognitive change typically starts, your brain health is optimized giving you the best chance of preserving cognition and staving off decline. Beau and Mercer Herman, Winter Park residents, are Certified Dementia Care Specialists and Senior Care Advisors/Owners of Assisted Living Locators Orlando Northeast, a free senior placement and referral service that helps you explore and understand eldercare options. Contact them at 407-498-2536 or visit www.assistedlivinglocators/orlando-northeast.

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ORLANDO || GRAND ROUNDS As Nation Seeks to Address Mental Health Issues, Florida Students Learn Ways to Get Help As the 2022 school year concludes, more than 77,000 Florida middle school and high school students have now participated in a mental health education program presented by HCA Florida Healthcare and EVERFI. This timely and critical digital curriculum aims at helping young people understand mental health disorders while removing the stigma associated with these conditions. In 2020, the Florida State Board of Education passed a rule requiring public schools to provide students in grades 6-12 with at least five hours of mental health instruction every year. In response, HCA Florida Healthcare and EVERFI moved swiftly to implement a digital Mental Wellness Basics program to help preadolescents and teens understand mental health disorders, reduce the stigma associated with mental illness and encourage action. Since that time, more than 77,000 students in 157 Florida public schools have completed the interactive digital curriculum. “It’s imperative that we reach young people with a message that mental health is just as important as physical health, particularly as we reset our lives after COVID-19,” says Melissa Arkin, regional vice president of behavioral health with HCA Florida Healthcare. “We must destigmatize mental illness, and that starts when kids are most vulnerable and, unfortunately, least likely to seek help.” The online instruction, divided into four interactive digital modules, is available to schools and students at no cost through HCA Florida Healthcare’s strategic partnership with the digital education provider EVERFI.

HCA Florida Poinciana Hospital Announces $9.9 Million Expansion to Increase Critical Care Capacity In response to the growing healthcare needs of Osceola and Polk counties, HCA Florida Poinciana Hospital, an affiliate of HCA Florida Healthcare, has announced a $9.9 million expansion of its intensive care and medical/surgical units. Expected to be completed by spring 2023, the project will double HCA Florida Poinciana Hospital’s Intensive Care Unit capacity from six to 12 beds, and add 18 additional inpatient medical/surgical beds. This will be the hospital’s fourth expansion since its opening in 2013. Upon completion, HCA Florida Poinciana Hospital will increase its bed capacity to a total of 94 inpatient beds. “HCA Florida Poinciana Hospital is committed to strategic growth and providing innovative solutions that benefit the needs of the communities we serve,” said Alex Romero, CEO of HCA Florida Poinciana Hospital. “With this

While the digital curriculum was designed to be implemented individually, teachers are provided offline resources for classroom and small group discussions to deepen the learning experience. In its third year of implementation, EVERFI developed the curriculum in collaboration with a team of counselors, psychiatrists and behavioral and public health professionals to equip students with the critical skills necessary to build and maintain their mental well-being. It also provides students with accurate information about mental health disorders, sharing peer experiences with mental illness and messaging that treatment is effective and available. According to the National Alliance on Mental Illness, one in six U.S. youth ages 6-17 experience a mental health disorder every year. Although half of all lifetime mental illness cases begin by age 14, the average delay between the onset of symptoms and intervention is ten years.

recent expansion, we will have increased capacity to serve the residents and visitors of Osceola and Polk counties for generations to come.” In November 2015, HCA Florida Poinciana Hospital completed a vertical expansion that more than doubled its number of private inpatient beds and in July 2019, the hospital added nine private rooms in its emergency department, expanding capacity to 31 private emergency beds. In October 2021, HCA Florida Poinciana Hospital completed construction of its first freestanding emergency department, HCA Florida ChampionsGate Emergency. HCA Florida Poinciana Hospital employs more than 400 full-time staff members. Additionally, the hospital has over 400 credentialed physicians and advanced practice professionals as part of its medical staff.

Orlando Health Cancer Institute Earns Accreditation in Rectal Cancer Treatment Orlando Health Cancer Institute has earned a threeyear accreditation from the National Accreditation Program for Rectal Cancer (NAPRC), a quality program of the American College of Surgeons. “Accreditation from NAPRC is granted only to those programs that are committed to providing the best care to patients with rectal cancer,” said Patrick Kelly, MD, rectal cancer program director at Orlando Health Cancer Institute. “Around the country, there are fewer than 50 cancer treatment centers that can say they have NAPRC accreditation so we’re very proud to be among a select group of specialists in our field.” Achieving NAPRC accreditation requires compliance with the high standards set forth by NAPRC, which sets top benchmarks for cancer care in quality, systemwide team collaboration, and excellence in patient outcomes. Orlando Health Cancer Institute, in collaboration with the Colon & Rectal Clinic of Orlando, earned accreditation for the expert care its rectal cancer specialists provide in surgery, pathology, radiology, radiation oncology and medical oncology. The Cancer Institute’s team approach ensures the treatment plan for every rectal cancer patient is developed by and based on the opinions of its expert physicians. Additionally, Orlando Health Cancer Institute met standards addressing the clinical services that the rectal cancer program provides, including carcinoembryonic antigen (CEA testing), magnetic resonance imaging (MRI), and computerized tomography (CT) imaging for cancer staging which allow patients to start treatment within a defined timeframe. Rectal cancer programs accredited by the NAPRC undergo a site visit every three years and are also accredited by the American College of Surgeons Commission on Cancer.

Assisted Living Locators Northeast Orlando Certified Senior Advisor® Beau Herman Receives Dementia Care Certification Assisted Living Locators, a nationwide senior placement service, has announced that Northeast Orlando franchisee owner and Certified Senior Advisor® Beau Herman is Dementia Care Certified®.

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of the Food Network. This free event will feature activities such as a rock-climbing wall, obstacle course, bungee run and more. Participants will also be treated to food, music and giveaways. Jones will anchor the Bash, sharing his inspiring story about how he rose from being a homeless teenager to become a successful, award-winning restaurateur whose dishes are now seen on Food Network’s “BBQ Brawl” show starring renowned chef Bobby Flay. Before he became a celebrated pitmaster and restaurant owner, Jones developed DOH-Marion’s BRAZEN program and managed it for eight years. In that time, he connected with hundreds of our community’s youth as a mentor and a motivational speaker, who related his beliefs of the importance of setting goals and making sound decisions to achieve them. “I’ve been very fortunate in having a lot of success in what I do, right here in Ocala. And a big part of that success comes from really having a clear-cut vision for your life, your choices, your future — really knowing what you’re aiming for,” said Jones. The BRAZEN program, he said, was founded on the idea of helping our community’s youth make “smart, healthy decisions.” “In order to make great decisions, you have to be the kind of person that stands out,” he said. “In life, we get to be the authors of the stories of our own lives. We get to take the pen, which is our choices, and we get to write on the pages, which are each day that we have in life. That’s the cool thing about each day. Each day is a new opportunity to create the kind of story you want in life.” “Brazen Bash is going to be exciting. You don’t want to miss it,” he added. “You’re going to learn how to make some amazing choices in life, and you’re going to learn how to aim for the top.” The Bash is exclusively for youth 11 to 18. It will be held 10 a.m. to 2 p.m. on June 30 at the Southeastern Livestock Pavilion, 2232 NE Jacksonville Rd., Ocala. Summer camp programs are encouraged to attend. For more information, visit brazenbash.org,

Assisted Living Locators and Dementia Care Education, the leading Alzheimer’s/dementia education, training, and consulting organization, recently announced a partnership to raise the bar and create best-practice service within the senior care industry. All Assisted Living Locators’ 140 franchisees are now dementia certified, with the majority choosing the Dementia Care Certified® designation, making it the first nationwide senior placement service to achieve system-certification. “With so many people in this community living with Alzheimer’s disease, a large number of my senior placements involve families having to locate assisted living or memory care for their loved ones,” said Beau Herman, Assisted Living Locators Northeast Orlando franchise owner. “Having the training and certification provided by Dementia Care Education allows me to better educate our local seniors and their families about the disease and what facilities are best suited for their needs.” For more information about Assisted Living Locators FREE service for seniors and their families, call Beau Herman at 407-498-2536 or visit https://assistedlivinglocators.com/care-advisor/orlando-northeast

OVAHCS Director, Timothy J. Cooke Receives the 2021 Presidential Rank Award

Orlando VA Health Care System (OVAHCS) Director, Mr. Timothy J. Cooke has been presented with the 2021 Presidential Rank Award which recognizes a select group of career members of senior executive service (SES) leaders for their exception performance over an extended period of time. It also recognizes those senior career employees with a sustained record of exception professional, technical, and/or scientific achievement recognized on a national or international level. In addition to effecting meaningful change, nominees must demonstrate the highest level of leadership acumen. Only one percent of the career SES may receive this rank. The Presidential Rank Awards, first established by the 1978 Civil Service Reform Act, go to career federal employees for their extraordinary work. This year there are 230 winners from 37 agencies who are all members of the Senior Executive Service, Senior-Level and Scientific and Professional corps. This is up from 141 winners in 2019 and 131 in 2018. “Mr. Timothy J. Cooke is certainly most deserving of this esteemed recognition,” said VISN 8 Acting Network Director, Dr. Edward Cutolo. “His leadership over the last two years at the OVAHCS has fostered innovation and he has demonstrated a steadfast commitment to the VA mission ensuring Veterans served across Central Florida receive the very best care. We are very proud of Mr. Cooke and his accomplishments throughout his career.”

HCA Florida Ocala Hospital and HCA Florida West Marion Hospital Nationally Recognized with an ‘A’ Leapfrog Hospital Safety Grade OCALA – HCA Florida Ocala Hospital and HCA Florida West Marion Hospital received an “A” Leapfrog Hospital Safety Grade for spring 2022. This national distinction recognizes HCA Florida Ocala Hospital and HCA Florida West Marion Hospital’s achievements in

NORTH CENTRAL FLORIDA || GRAND ROUNDS DOH-Marion Offers Our Youth a Summer Event They Won’t Want to Miss OCALA — NBA legend Michael Jordan once said of setting goals, “You must expect great things of yourself before you can do them.” With that in mind, the Florida Department of Health in Marion County is hosting a free, fun summertime event that will entertain, enlighten and educate our community’s young people about finding success in our increasingly complex world. DOH-Marion’s BRAZEN team is holding Brazen Bash ’22, featuring the dynamic Rashad Jones, owner of Big Lee’s Serious About BBQ restaurants in Ocala and a star

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protecting patients from preventable harm and error in the hospital. They are Ocala’s only hospitals with an A rating for patient safety. "We're incredibly proud of our team who puts patients first every day," said Chad Christianson, CEO of HCA Florida Ocala Hospital and HCA Florida West Marion Hospital. "It takes everyone's focus and dedication to achieve an A rating from The Leapfrog Group, and to have earned it at both of our hospitals is no small feat. We are proud to offer best in class healthcare to the greater Ocala community that we serve." The Leapfrog Hospital Safety Grade is the only hospital ratings program based exclusively on hospital prevention of medical errors and harms to patients. The grading system is peer-reviewed, fully transparent and free to the public. Grades are updated twice annually, in the fall and spring. “As our health care system continues to feel the strain of the pandemic, I thank the workforce and leadership of HCA Florida Ocala Hospital and HCA Florida West Marion Hospital for sustained commitment to patient safety, day in and day out,” said Leah Binder, president and CEO of The Leapfrog Group. “An ‘A’ Safety Grade is an outstanding achievement, and one that is not possible without a 24/7 effort by the entire health care workforce to protect patients from harm. This community should be proud.”

The Marion County Community Health Assessment is Underway Ocala — Creating a healthier, more vibrant community does not happen in a vacuum. It requires collaboration, determination, and information. Which is why the Florida Department of Health in Marion County and its partners at AdventHealth Ocala and the WellFlorida Council are seeking the community’s input for our new health survey. We are inviting the Marion County residents to visit tinyurl.com/MarionHealthSurvey to help us learn which health and wellness issues are most important to them. The survey takes about 10 minutes to complete. A separate survey is available to gain feedback from local healthcare providers. That can be found at tinyurl. com/MarionProviderSurvey. Responses are gathered anonymously, protecting the privacy of respondents. The information provided by the respondents will be compiled in a report that will be released this fall. Community leaders will use that report to chart strategies to make all of Marion County healthier. In years past, AdventHealth Ocala also has done its own assessment. For 2022, DOH-Marion and AdventHealth decided to combine forces to better gauge our community’s overall health and wellness needs. WellFlor-

to 700 new jobs to the area upon completion. “We’re excited to join AdventHealth and our project team in celebrating this significant construction milestone,” said Angel Colon, operations manager for Robins & Morton, general contractor on the project. “We’re proud to continue our long relationship with AdventHealth as a construction partner and honored by the trust they’ve placed in us to help them fulfill their healthcare mission.”

ida Council, our region’s health council and a consultant for health causes in our area, is facilitating the survey. “Our partnership with AdventHealth in conducting the Community Health Assessment is a force multiplier in working toward a healthier Marion County,” said Mark Lander, administrator of the Department of Health in Marion County. “But the process starts with the residents of our community. The assessment is like a GPS system guiding us on how to improve the health and wellness of all of Marion County. But we need the community’s help in determining which direction to go. That’s why I encourage residents to assist us by taking a few minutes to complete the survey.” Kimberly Williams, director of Community Benefit for AdventHealth West Florida Division, said, “AdventHealth is committed to building a stronger, healthier community in Marion County and we look forward to working with the Marion County Department of Health to identify and better understand the needs of the communities we serve.” “This assessment is an essential step in creating collaborative community initiatives that remove barriers and in turn create access to proper care and a better quality of life,” she added. Christine Abarca, senior planner for community initiatives with WellFlorida Council, said, “Quantitative data from an array of datasets can only describe part of a community’s health needs and health issues. Gathering the community’s perspective of health status, health issues and problems, and the healthcare experience is essential to fully understanding a community’s health and quality of life.” “Analysis of the data collected through a robust survey effort results in a stronger understanding of community issues, concerns, and perceptions about quality of life through the lens of community members, healthcare providers, and other community partners,” she continued. “These data help inform the identification of strategic health issues, point to priority populations, and suggest potential strategies to address problems.” The link for the survey will be available until June 10. This is part of a process that DOH-Marion must conduct every three years in order to update the Community Health Improvement Plan for Marion County. For more information about the surveys, contact Kimberly Williams, community benefit director at AdventHealth Ocala, at Kimberly.R.Williams@AdventHealth. com or 813-803-4028, or Craig Ackerman, operations director for the Department of Health in Marion County, at Craig. Ackerman@flhealth.gov or 352-644-2588.

Parrish Healthcare Implements Innovative Program to Provide Healing to those Suffering from Addiction TITUSVILLE – When someone is traveling a dark and dangerous road, an experienced guide can make the difference between tragedy - or arriving safely. For people on the ever-challenging path of recovery from mental health diagnosis or addictions, their Parrish Healthcare “guides” – members of Parrish’s Peer Recovery Specialist (PRS) Network - are valuable members of a team of caregivers working together to help people in crisis reclaim their lives and return them to their families. “The path to recovery is made easier when a person walking it knows they’re not alone, and that with them is someone who has shared experiences and has recovered from them,” said Lara Chicone, LCSW Parrish Healthcare behavioral health navigator and peer recovery program coordinator. “Our mission at Parrish is ‘healing experiences for everyone all the time,” Chicone added. “The Peer Recovery Specialist Network is an extraordinarily valuable help for people who are searching for a way out of the situation in which they find themselves.” Born from a Parrish Community Health Partnership and Circles of Care collaboration, the PRS network members are specially trained to use experience, knowledge, and care to help others overcome what team members have faced. Mental health and addiction disorders impact 47% of the North Brevard Community and represents one of the top social determinants of health priorities according the Community Health Needs Assessment conducted by Parrish Healthcare. In fact, the CDC recently released a report that states 2021 was a record year for overdose deaths with an estimated 107,622, an increase of 15% from the previous year. Behind every statistic, there’s a face, a name, and a story. Most people undergoing these trials don’t want to be in them. In cases of addiction, it is often a gradual yet unrelenting decline until they find themselves in a position they can’t get out of. Mental health conditions present a different set of priorities and approaches. However, whether it’s mental health or addiction, the goal is the same: recovery.

VOLUSIA/BREVARD || GRAND ROUNDS AdventHealth ‘Tops Out’ Palm Coast Parkway Hospital AdventHealth Palm Coast Parkway has taken a significant step forward, as hospital and construction team members gathered to celebrate the building’s “topping out.” Topping out is a construction tradition celebrating the installation of the final beam of a structure, signifying structural completion of a building. “We are proud to celebrate this milestone in the building of our second Palm Coast hospital,” said Audrey Gregory, CEO of AdventHealth’s Central Florida Division – North Region. “This facility will allow us to provide a comprehensive range of care close to home for all the residents of Flagler County and surrounding areas.” The four-story hospital, located on the north end of the county near Bridgehaven Drive, will be approximately 158,000 square feet. It will include an emergency department with full-service imaging; five operating suites; endoscopy services; outpatient laboratory; heart catheterization labs; 20 critical care patient rooms and 80 general medical or surgical care rooms. AdventHealth broke ground in September on the 100bed hospital. It is expected to open in spring 2023, bringing additional inpatient care services to the fast-growing population of Flagler County. Plans also call for a 30,000-square-foot medical office building to be constructed as part of this $162 million project. AdventHealth Palm Coast Parkway will bring up

Taking Flight: Life-saving Whole Blood Now Aboard First Flight

Carrying whole Type-O blood on board air ambulances is rare in Florida – but makes all the difference for the most vulnerable trauma patients. If the sight (or even mention) of blood makes you a little weak in the knees, perhaps read no further. But a recent decision by Health First to supply First Flight air ambulance crews with whole Type-O blood just might be a lifesaving gamechanger, making Brevard County one of the first in the state to have this added layer of trauma care. Why does the type of blood aboard medical air ambulances matter when they’re already amply equipped to save lives? Typically, critical trauma patients are given blood

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“parts” – packed red blood cells and liquid plasma. These unit components offer more diversity for treatment, but whole blood means all of the components are together at once. Less interruption in care, lower total volume. “For our trauma patients, the ability to provide whole blood in the prehospital setting at the earliest point of patient care is exciting and groundbreaking for our region. Use of whole blood in this setting in both military and civilian studies suggest that whole blood may reduce mortality, which is our primary goal,” said Dr. Peter Depowski, Medical Director of Health First Transfusion Services. Dr. Depowski credited the health system’s blood supplier, OneBlood, for a fruitful collaboration, and he said his team recently validated the larger blood coolers required to carry whole blood aboard First Flight. In extreme cases, bleeding is so quick and heavy that patients suffer every minute from the absence of a whole blood transfusion. On average, First Flight performs about 12-15 transfusions a year, says Rob Spivey, First Flight Nurse Manager, or about one a month. Since October the operation has been averaging two a month. Now, life-saving whole blood transfusions can be made before arriving at Brevard County’s only Level-II trauma center at Holmes Regional Medical Center, making First Flight the state’s only air ambulance to provide begin blood enroute. Blood transfusions to save the lives of hemorrhaging patients is about 200 years old, but blood component therapies became the standard of care after the Vietnam War era. The wars in Afghanistan and Iraq, though, renewed the need for more direct and robust resuscitation, and whole blood’s use in far-forward military operations showed high stability and dramatic decreases in mortality. Spivey says he is aware of a south Florida county air ambulance system that intends to begin boarding whole blood but hasn’t yet. He said he expects all of Central Florida to jump on this trend soon. “This has been a great collaboration between the First Flight team, the Blood Bank at Holmes Regional Medical Center and our blood supplier, OneBlood,” Dr. Depowski said.

Halifax Health Unveils Apprenticeship Program As part of a company-wide initiative to provide our local community and existing Team Members with access to valuable workplace training and career opportunities, Halifax Health is proud to unveil its newly launched Apprenticeship Program, following approval by the Florida Department of Education. This exciting new designation allows existing – and future – Team Members to explore career paths such as Nursing, Coding, Pharmacy Tech and more. The Apprenticeship program was designed with the overarching goal of continuing to develop a highly-skilled workforce. As noted by Kim Fulcher, Human Resources, Senior Director, “Work-based learning in a hands-on environment opens the door to limitless possibilities.” Using a systematically structured process, apprentices receive tools and training specific to their focus area, gaining valuable experience and education in a supportive work environment, allowing them to work alongside experts in fields that they might not have otherwise considered. Since opening our doors in 1928, Halifax Health has been committed to creating a workplace culture centered on Team Member growth and development. The flagship concept of “Earn While You Learn” presents individuals in the workplace with a unique opportunity to acquire new skills and earn a living, while simultaneously embarking on an exciting new career path. Apprentices receive the following: • Relevant job skills • Hands-on training • Mentorship • Academic scholarships • Relevant curriculum and certification • Monetary compensation • Future career opportunities • U.S. Department of Labor Certificate of Completion To get more information, please email orgdevelop@ halifax.org or call 386.425.1465.