Lacie the golden retriever visits a patient at Mahaska Health Partnership in Oskaloosa.

There are many things that hospitals do within their physical environments to promote healing.  Large, private patient rooms with big windows and plenty of room for visitors.  Comfortable, airy waiting areas with access to Wi-Fi.  Inviting outdoor spaces (or outdoor-like spaces that are actually indoors).

People are also important; visitors bring encouragement, socialization and a connection to home.  But sometimes people can be overwhelming.  That’s when special visitors like Lacie are needed.

Lacie is a beautiful, unassuming golden retriever who makes weekly visits to Mahaska Health Partnership (MHP) in Oskaloosa.  On other days, her friends Lincoln and Yeager, also golden retrievers, are at the hospital.

While all volunteers are important members of the hospital health care team, the three golden retrievers and their trainers, Oskaloosa residents Vicki Koger and Victoria Laird, play a special role in providing comfort in a way that increases emotional well-being and promotes healing.

The MHP dogs are graduates of Therapy Dog International (TDI), a volunteer group organized in 1976 to provide qualified handlers and their therapy dogs for visits to institutions, facilities and any other place where therapy dogs are needed. Canine membership includes both purebred and mixed breed dogs. All dogs are tested and evaluated for Therapy Dog work by Certified TDI evaluators. While many dogs provide love and companionship in the home, not all dogs are qualified or have the temperament suited to be a therapy dog.

Each dog is also required to have an annual health record form that is completed and signed by a licensed veterinarian. According to MHP policy, patients must also agree ahead of time that they would like a visit. Hand hygiene is strictly enforced and the handlers must be present for each visit.

Therapy dogs, or animal-assisted therapy, are also popular in large hospitals, like University of Iowa Hospitals and Clinics (UIHC).  The Furry Friends program started at UIHC as a joint

Looby is one of several very popular therapy dogs at the University of Iowa Children's Hospital.

effort between the recreational therapy and volunteer programs in 2003; seven certified dogs are members of the service, ranging from Sophie, an eight-pound Pomeranian, to Yuki, a 70-pound labradoodle.  The animals visit adult and children patients in all areas of the hospital, but they are particularly popular in the children’s hospital.

Research shows that in addition to all of the positive emotional feelings associated with therapy dogs, having a relationship with an animal can reduce stress levels, lower blood pressure, decrease loneliness, and create feelings of overall well-being, said UIHC child life program manager Gwen Senio.

MHP’s pet therapy program is currently utilized on the inpatient unit and at Vision Quest, MHP’s geriatric psychiatry unit designed to diagnose and treat the complex problems of senior adults. The dogs are also spending time at the MHP Hospice Serenity House, the new residential hospice facility on MHP’s campus.

“I truly didn’t realize it would be so special for everyone involved,” Laird said. “I’m learning to listen to Lincoln, because he seems to sense who needs him. I know how relaxing and what a stress relief being with a dog is, and since Vicki and I both had such affectionate, loving dogs, we thought this would be a great way to share them.”

Koger agreed and said she was surprised by the positive reactions not only from the patients but also staff. “I even get hugs from the staff. They know each dog’s name and they are very happy to see us when we come to visit. I truly believe we are doing God’s work, and my husband and I often pray over our dogs. We all see the emotional and physical healing people can get from this experience.”

According to Vision Quest Nursing Director Lisa Cox, MHP’s pet therapy program has been a welcomed addition since it was re-established last spring. “We have a dog come visit us three times a week,” Cox said. “After visits, patients often ask when they are coming back.

“Medical studies have proven that pet therapy benefits patients. People who are sick, lonely and even depressed will often respond to an animal offering genuine affection and unconditional love.”

“People are often unaware of the contributions that hospitals make to their local economies, including the number of people they employ, the significance of hospital purchases with local businesses and the impact of their employees’ spending for the entire region,” said Kirk Norris, IHA president/CEO.  “Just as no one provides the services and community benefits found at our hospitals, there is also no substitute for the jobs and business hospitals provide and create.”

The IHA study examined the jobs, income, retail sales and sales tax produced by hospitals and the rest of the state’s health care sector.  The study was compiled from hospital-submitted data on the American Hospital Association’s Annual Survey of Hospitals and with software that other industries have used to determine their economic impact.

The study found that Iowa hospitals directly employ 70,363 people and create another 65,783 jobs outside the hospital sector.  As an income source, hospitals provide $3.9 billion in salaries and benefits and generate another $2.3 billion through other jobs that depend on hospitals.

In all, Iowa’s health care sector, which includes employed clinicians, long-term care services and assisted living centers, pharmacies and other medical and health services, directly and indirectly provides 333,554 Iowa jobs, or more than one-fifth of the state’s total employment.

Complete information from the study, including economic impact data for each of Iowa’s hospitals, is available on the IHA website.

In November, 58 communities were invited to submit applications based on previously submitted statements of interest indicating their desire to become a Blue Zones Project demonstration site. These communities were chosen based on a mixture of criteria, including civic structure and engagement and how many residents live and work within the community.  Collectively, the 54 communities that provided applications represent the geographic and demographic diversity of Iowa.

Hospitals continue to be key players and motivators in the Blue Zones process.

“Promoting healthier lives has always been the mission of Spencer Hospital and it’s really exciting to see such a great grassroots effort in our community working to achieve Blue Zones status,” commented Bill Bumgarner, CEO at Spencer Hospital. “Community members are already embracing health improvement initiatives and striving to live healthier.  We anticipate this movement continuing to grow with the potential support of the Blue Zones initiative.”

“Assuming an even greater accountability for the wellness of our community is an exciting and daunting challenge,” said Susan Thompson, CEO of Trinity Regional Medical Center in Fort Dodge.  “I am pleased the Fort Dodge community has embraced this opportunity and stepped forward in partnership. As the community hospital and leader in health promotion, we are very engaged in this process remaining hopeful while looking forward to be named a Blue Zone community.”

Teresa Newman

Teresa Newman, Trinity Regional’s healthy living manager, has been one of the leaders in Fort Dodge’s Blue Zones effort.  She said the application process was beneficial.

“Many of us on the committee were unaware of programs currently offered by various businesses in our community,” Newman said.   “This new-found awareness will allow us to work together to enhance and collaborate our current program offerings as well as develop new programs.  That was definitely an unexpected benefit of the Blue Zones application process.”

Upon assessment of the applications, up to 10 finalist communities will be announced on February 10.  These selected communities will host site visits from February 27-March 16.  This process will culminate with the selection of the demonstration sites in May.

Communities not chosen as demonstration sites will also benefit.  An Iowa “Blue Zones Institute” is being established this year to provide leadership training and tools to help leaders transform their communities, work places and home environments, using a self-directed approach to becoming a Blue Zones Community.  An online learning collaborative to showcase how communities have implemented Blue Zones principles as well as a suite of online tools is also being developed.

For more information in the Iowa Blue Zones Project, click here.

An Iowa Health-Des Moines nurse checks on a newborn.

Miracles happen at hospitals every day.  Nowhere is that more evident than on the obstetrics unit – where the babies are.  This is not just where infants are born, it’s where families are made and enhanced.  It’s where lives are changed in a way that is joyous and forever.

But there was no miracle for the twin girls born late last week and then found dead in the trunk of their mother’s car in Story County.  Now their mother, Jackie Burkle, is facing murder charges.  Few details have emerged about the case, but there is only real question:  Why?  What would lead a young woman to give birth and then allow – if not purposely bring about – the deaths of her infant daughters?

This is particularly frustrating for hospitals and the people who work in them, not only because they are mission-bound to protect lives, particularly the lives of children and other vulnerable people, but because there are laws – laws that hospitals advocated for – to help these mothers in distress and their babies.

Iowa’s “safe haven” law was put on the books in 2001.  Under the law, which was strongly supported by IHA, unwanted babies age 14 days or younger can be surrendered at a hospital or even a nursing home.  The law provides that the child’s parents will be immune from prosecution (assuming the child is unharmed), their identities will be kept private and the child will be cared for and eventually adopted.

Fourteen Iowa infants have been adopted under the law.  But, sadly, at least a half dozen have died since then in circumstances similar to those playing out in Story County.

In response, IHA worked with the Iowa Department of Human Services (DHS) and former Iowa First Lady Mari Culver to produce television (see video below) and radio ads in 2007 that explained the law and promoted hospitals as safe havens.  The ads ran that summer on television and radio programs that were popular with young people.

Up to that time, nothing formal had been done to publicize the law.  With information and assistance from IHA, hospitals put up signs and promoted the law with their local media when it was first passed.  But, except for that summer nearly five years ago, no money has ever been allocated by the Legislature to keep the public aware of safe havens.

Maybe it’s time that a coalition of Iowa human and health services organizations (including hospitals) – as well as state agencies – figured out how to ensure that a minimal year-to-year effort is made to raise safe havens awareness.  It may never be enough to keep these tragedies from happening, but safeguarding the lives of newborns deserves more than nothing.

Beginning this month, Lakes Regional Healthcare at Spirit Lake will join the network of hospitals participating in URMED, which also includes BVRMC, Humboldt Community Hospital, Loring Hospital in Sac City and Pocahontas Community Hospital. The increase in hospital participation also created an additional internship position in the program.

BVRMC provides experiential learning opportunities throughout the academic year for BVU students pursuing careers in medicine and other health care professions, says Dr. Richard Lampe, professor of biology who helped develop the URMED partnership. Lampe is also current chair of the BVRMC Board of Trustees.

The capstone of the URMED program is an intensive January internship for selected BVU pre-med students who have an interest in practicing rural medicine. Students compete for the January internship slots, which include $3,000 stipends to help defray the costs of applying to medical school.

The URMED program was designed as one possible solution to the impending national shortage of physicians and other health care practitioners in rural communities. URMED has attracted interest from the University of Iowa Carver College of Medicine as well as a national program that seeks to interest young people in health care careers, notes Lampe.

URMED program interns (in white coats, left to right) Sabrina Martinez, Cammy Matters, Whitney Nelson and Alex Davis are joined by Rob Colerick, CEO of Buena Vista Regional Medical Center.

While the URMED alumni have no obligation to return to the communities where they interned, BVU science faculty, and officials at BVRMC and the other participating hospitals stay in regular contact and build ongoing relationships with them. “We have already seen interest in several medical students in coming back to Storm Lake to practice,” notes Lampe. The URMED program is also attracting new students interested in health care careers to BVU, he notes.

Students selected for the 2012 URMED January internships are:

• Cammy Matters, a junior biology major from Humboldt
• Whitney Nelson, a junior biology and history double major from Audubon
• Alex Davis, a junior biology major from Webster City
• Sabrina Martinez, a non-traditional student from Storm Lake, who is completing her pre-med course requirements at BVU. A 2008 Columbia University graduate in political science, she is a former admissions representative and assistant director of admissions at BVU.

Matters, Nelson and Davis will each intern at BVRMC for two weeks and then one week at the hospitals in Humboldt, Sac City, or Pocahontas. Martinez will spend all three weeks of her internship at Lakes Regional Healthcare at Spirit Lake.

During their internships, the students will work alongside physicians and other health care practitioners to learn what it is like to interact with patients in hospital, surgery, emergency room and clinical settings. They can also attend lectures and continuing education programs for medical staff.

The participating hospitals and BVU, through donor support, provide the financial resources for the stipends. “This year we had nine very fine URMED applicants but could only fund the four internships,” notes Lampe. “If we had additional financial support and participation from other area hospitals we could grow the program to accommodate the interest that our BVU students are showing in rural medical careers.”

So far, six BVU graduates and two current students have completed URMED January internships. Two are now enrolled in medical schools and others are working in related fields and plan to reapply to med schools, or are in graduate programs.

Two 2009 BVU graduates, Kyle Glienke of Aurelia and James Alstott of Laurens, also completed internships at BVRMC that became the model for the URMED program, says Lampe. They are third-year medical students at the University of Iowa Carver College of Medicine and were on campus in September to talk with URMED students about their experiences in medical school.

Things have changed. Oh, Iowa is still low on Medicare per-enrollee spending, though we’ve moved from the bottom five to the bottom 10.  But at least the data is there – and there’s plenty of it to mull over as the report covers two decades of health care spending by Medicare, Medicaid and the population as a whole.  And though there are a lot of numbers, there are not a lot of easy answers about why the numbers are so different from one place to the next.

Here’s what the numbers tell us.  First, states with relatively low per-capita spending tend to have younger populations that don’t “use” a lot of health care, like Utah (median age: 28.8; annual per-capita health care spending: $5,031).  They also have another group that tends to use less care – the uninsured – like Texas (percent of population uninsured: 26 percent; annual per-capita health care spending: $5,934).

Iowa sits in the middle (28^th) for per-capita health care spending at $6,921.  This may seem surprisingly high, but it makes sense because Iowa is well insured (10 percent uninsured – only three states do better) and has a relatively large population of senior citizens (15 percent of Iowans are 65 years or older, the fifth highest rate in the nation).  Massachusetts provides the perfect storm for pushing up health care costs: nearly everyone is insured (4.4 percent uninsured) and the median age is high (39).  But most important is Massachusetts’ unrivaled density of medical providers; the state has one physician for every 189 people; in Iowa, there is one physician for every 479 people.  No wonder Massachusetts’ per capita health care spending is $9,277 (the highest of all states and 30 percent more than Iowa).

Older people are more expensive to keep healthy than younger ones, which is why in nearly every state (Alaska is the exception) more money is spent on each Medicare recipient than on the typical resident.  In Iowa, it’s about 22 percent more; in 18 states, it’s at least 50 percent more.  Some of that difference can be explained by a relatively young total population that keeps per capita costs down in some states.  However, while there are a lot of uninsured in Texas and the median age is 33 (it’s 38 in Iowa), that doesn’t completely explain why a Medicare patient costs nearly twice as much as a plain ole Texan, on average.  It certainly doesn’t make sense in Florida, where the median age is 40 but a Medicare patient costs 66 percent more than everybody else.

What about Medicaid?  Well, Medicaid doesn’t serve the same populations as Medicare – not exactly, anyway.  Most significantly, many Medicaid recipients are children or young mothers, so you’d expect Medicaid costs per enrollee to be quite a bit less than Medicare and about the same as everybody else (or somewhat higher because many Medicaid recipients are dealing with chronic health problems).  In Iowa, that’s exactly the case – the cost per Medicaid enrollee is 99.5 percent of the cost of a typical Iowan.

However, the real cost of taking care of a Medicaid patient is significantly higher – Iowa hospitals and physicians lose millions of dollars a year because of Medicaid underpayment.  But it could be worse.  California, which spends nearly $11,000 on each Medicare patient each year (ninth highest in the nation), spends only $4,569 on each Medicaid patient (the least in the nation).

Does that mean Iowa is spending too much on Medicaid?  Only if you feel ok about scores of physicians refusing to be part of the program, effectively making millions of Medicaid patients uninsured.  That is precisely what has happened in California, which is more than happy to take advantage of low-cost states like Iowa to pump up its Medicare spending, while strangling providers with ridiculously low Medicaid payments and thereby cutting off health care to millions of the state’s poorest and most vulnerable citizens.

“Wide variation” comes up a lot when discussing numbers like these and how much is spent on seemingly the same patient groups in different parts of the country.  As this brief discussion shows, there are many factors to consider.  Still, while the actual cost of providing health care may be more in Manhattan than Marengo, it doesn’t completely explain why a New York Medicare patient costs 31 percent more and a Medicaid patient costs 37 percent more than the same patients in Iowa.

It is complicated, but it starts with providing value and making value a strategic priority in every Iowa hospital.  It’s about providing quality care, not just quantity care.  And it’s about putting patients first.

That is IHA’s mission statement, and it’s a good one. Basically, IHA helps hospitals do what they need to do to meet the expectations of their communities by educating hospital staff, collecting data that helps hospitals plan and representing Iowa hospitals in Des Moines and Washington, D.C. 

That last part means IHA is a lobbying organization, not unlike other lobbying organizations that work on behalf of farmers, builders, school teachers, school boards, restaurants, grocers, insurance companies, lawyers, newspapers and dozens of other industries and organizations, including many non-profits, from Boys and Girls Clubs to Ducks Unlimited to Easter Seals. 

Some people don’t like lobbyists; one of those people may well be Dean Lerner. Which would be more than a little ironic, since the Department of Inspections and Appeals, the state agency Lerner used to run, has its own lobbyist. 

Certainly Lerner dislikes IHA, leaving one to wonder if he doesn’t feel the same way about the hospitals that make up IHA’s membership and drive the Association’s lobbying priorities. For the record, that would be every hospital in the state. 

It’s a little hard to tell just what Lerner’s mission is, even after several reads of his 650-word opinion in Sunday’s Des Moines Register.  Well, maybe it’s not that hard, as Lerner concludes early on that “hospitals…have come to reflect the values of Wall Street,” though he doesn’t bother to explain what that means or how it has affected one of the highest quality, most efficient health care systems in the country. 

But it is obvious Lerner doesn’t like that there are hospitals in West Des Moines (a city of nearly 60,000 people located in the fastest-growing region in the state that Lerner, nonetheless, describes as “nowhere”) even though these hospitals see nearly 2,000 patients each month – in just their emergency rooms. 

He doesn’t like Iowa’s smallest hospitals, either, because the federal government has the temerity to pay these hospitals 1 percent more than their cost of care. Lerner doesn’t seem to mind at all that these hospitals are almost completely dependent on Medicare and Medicaid dollars for their survival and that, without the Critical Access Hospital Program, their buildings would remain best suited for medicine as it was practiced 50 years ago. 

Maybe Lerner doesn’t realize that Iowa hospitals, particularly in smaller counties, are often the largest employer and always an economic cornerstone for a state desperate to attract and keep young, well-educated workers and their growing families. His position seems to be that these hospitals, and the communities they serve, should just get it over with and die. 

He also apparently believes hospitals should not be tax-exempt, though, once again, does not say why. He doesn’t think Medicaid losses by hospitals should count as a community benefit, though it’s difficult to imagine a greater benefit to taxpayers than the $196 million hit Iowa hospitals take each year to keep the program afloat (not to mention $63 million lost to Medicare).  

He doesn’t think a half billion dollars in charity care and another $67 million in additional health care services are enough. He doesn’t think $344 million lost to people who simply decide not to pay their hospital bills is enough. And he apparently has ready replacements for hospitals and the millions they expend supporting and improving the health of their communities through education, counseling, sponsorships and research that extend above and beyond day-to-day patient care. 

If he does have a different idea, rest assured that it will come at the expense of the communities that hospitals serve, the same communities filled with Iowans who each year donate millions of dollars and thousands of volunteer hours to their hospitals. It is those communities and their representatives that drive each hospital’s mission – the mission that IHA represents and supports. 

Because there is one thing Lerner does manage to make clear – he is still the dedicated former bureaucrat who would gladly add more layers of legislation, regulation and expense to health care, ultimately making nurses and physicians more accountable to the government than to their patients and communities. 

That’s a mission Iowa’s hospitals will not support, and neither should the people of Iowa.

Future HCAHPS respondents...and they could be from anywhere.

“I think the focus needs to be on what staff, physicians and leaders can do to improve the patient experience instead of the ‘throw up your hands’ approach and blaming patients for being more difficult,” said David Brandon, CEO of The Finley Hospital in Dubuque.  “You cannot have an ‘opt-out’ culture if you’re going to succeed in creating an exceptional patient environment.” 

Both Sioux City and Dubuque are in multi-county hospital referral regions (HRRs) that rank in the top 20 nationwide for patient satisfaction.  The HRR around Mason City ranks at the top.  Meanwhile, out of nearly 300 HRRs, Manhattan is dead last and Cleveland is 237^th. 

“Where many CEOs fall down is they see this as a fluff kind of thing,” said Greg Paris, CEO at Monroe County Hospital in Albia, who received IHA’s hospital leadership award in 2007 in part for his work to pull that hospital’s patient satisfaction scores out of the basement.  “What they don’t realize is that satisfaction is directly related to quality outcomes, financial results and employee engagement.”

But, he added, “Smiles and singing don’t drive satisfaction.” 

Paris talks about how using key words reduces patient anxiety, which improves compliance with care plans and leads to better outcomes.  Hourly rounding (“I hear large hospitals gasping,” Paris laughed) reduces patient falls by 50 percent.  Checklists reduce errors.  Discharge calls save lives because one in six patients has an adverse health event after they go home.  Lower employee turnover means fewer mistakes and less harm to patients. 

But shouldn’t getting the highly touted care at Cleveland Clinic or NYU be enough?  The better question – the one really being asked through HCACHPS and Hospital Compare – is why not expect high-quality care and a first-class patient experience?  Anyone who has made use of the Iowa Healthcare Collaborative’s “Iowa Report” will see Iowa hospitals are uniformly committed to both. 

“Yes, we need to have the right facilities and evidence-based strategies in place, but more than anything else it is the never-ending commitment to create a culture that holds service in the highest regard,” said Brandon.  “Without the right culture, the strategies and facilities alone will not allow you to meet the expectations of your patients.” 

And because of the growing amount of publicly available data, hospitals cannot depend on just their word-of-mouth reputations or referrals.  “The next generation will pick their hospital based on outcomes and experience, not just by where their doctor sends them,” noted Paris.

Grundy County Memorial Hospital

Eighty-four communities in Iowa have submitted a “statement of interest” to become one of 10 demonstration sites for the state’s Blue Zones Project.  Submission of the statement of interest is the first step of the application process for the Blue Zones Project.  About three-fourths of the 84 communities are home to at least one hospital – and hospitals have taken leadership roles to bring Blue Zones home. 

The Blue Zones Project is based upon findings from an eight-year worldwide longevity study to identify common elements of the world’s longest-lived cultures.  Blue Zones uses third-party research and direct studies to identify the world’s best practices in longevity and well-being. Working in collaboration with the University of Minnesota School of Public Health, it uses this research to develop lifestyle management tools.  In 2009, Blue Zones led a 10-month pilot project in Albert Lea, Minnesota, where residents increased their projected life expectancy by 2.9 years.  In addition, employers in that city reported a decline in health care claims cost and a drop in absenteeism. 

“Iowans have sent a clear signal that they are eager to improve their well-being,” said Justin Smith, co-leader of the Blue Zones Project.  “During the road shows, we were impressed by the passion shown by communities throughout Iowa and we look forward to the next stage in this exciting journey together.” 

Blue Zones is tracking community interest in the project and one of the leaders from the start has been Grundy Center. There, Grundy County Memorial Hospital has been a highly active Blue Zones supporter and leader.  “For us, this is a very mission-driven project,” said hospital CEO Pam Delagardelle.  “The path to becoming a Blue Zones community aligns perfectly with our hospital’s mission of ‘improving the health of the communities we serve.’”  

“It’s a perfect time for our hospital to drive this initiative for our community – we have the local infrastructure in place with strategic partners like public health, the school district, and local businesses all actively involved in community health implementation.  The prospect of transforming our community’s well-being is exciting and energizing and our stakeholders are prepared to align efforts to accomplish the transformation.” 

Algona is another place that has received significant community support for its Blue Zones application and Kossuth Regional Health Center (KRHC) has led the way with several staff members joining in the community-wide effort.  “We know that lifestyle choices make a big impact on people’s overall health and see great value in investing in wellness opportunities for the community and on behalf of our own employees,” said KRHC CEO Scott Curtis.  

“We have encouraged staff from all areas of the hospital to get involved and have engaged physicians, public health nurses, business health staff and others in this effort so far.  In addition to working on plans and ideas for the overall community, at KRHC we have also started introducing Blue Zones concepts to our employees.” 

After the statements of interest are reviewed, select communities will be asked to submit a formal, detailed application to become one of 10 demonstration sites to receive assistance in developing and implementing a blueprint for making permanent environmental, policy and social network changes that transition people into healthier behaviors.  These communities will share their learnings with other communities in Iowa. 

The invitations to submit formal applications will be extended to communities by November 23, and the applications must be submitted by January 4, 2012.  Upon assessment of these applications, a group of finalist communities will then be selected to host a site visit between February 27, 2012 and March 16, 2012.  This process will culminate with the selection of the first group of lead communities in May of next year. 

Well-being improvement in the participating communities will be measured using the Gallup-Healthways Well-Being Index, the first-ever daily assessment of U.S. residents health and well-being.  Well-Being Index data reveals a significant opportunity in Iowa for improvement, particularly among healthy behaviors and work environments.  Iowa currently ranks 19^th on the index; the Iowa Healthiest State Initiative, of which the Blue Zones Project is a centerpiece, aims to pull Iowa to the top of the index  by helping employers and communities achieve greater well-being, which should lead to lower health care costs, higher productivity and increased economic viability.

Regulators demand a lot from health care providers and it does impact care for patients – but that impact is not always positive.  One study found that for every hour of patient care, there is at least 30 minutes of paperwork.  In some settings, the ratio is one-to-one: one hour of paperwork to every hour of patient care. (The Obama administration recently announced steps it was taking to reduce regulatory red tape hospitals face.)

Does this mean hospitals are against regulation?  Absolutely not.  Hospitals recognize and honor the need for consistency, guidance and accountability because, in the end, providers and regulators are seeking the same thing: the right care for every patient, every time.  As David Vellinga, CEO at Mercy Medical Center-Des Moines, recently wrote: “While these processes can be burdensome at times, we at Mercy understand they are important parts of continuously improving quality — necessary steps in the journey toward perfect care.” 

The work to comply with regulations, inspections and surveys is no less for a smaller hospital.  “At times it is difficult to look beyond the minutia of regulations to see the intent,” said Sharon Taylor, who serves as the compliance officer at Burgess Health Center in Onawa.  “However, the intent of the majority of regulations is to be sure that treatment, payment and health care operations are delivered to our patients in a safe and effective manner.” 

Another reality is that nearly every hospital employee is affected by regulations and has a role in knowing and complying with them.  To prevent infections, housekeeping staff need to know that different cleaners must be used in different rooms and situations and they need to know how to use those cleaners safely and effectively.  Plant operations staff need know where hand gel dispensers can be mounted to comply with fire regulations.  And all staff are routinely trained on patient safety and privacy regulations. 

But, despite the hard work of staff, mistakes do happen.  “Employees come to work to do a good job, they don’t come with the intention of making a mistake or breaking a regulation,” Taylor said.  “Sometimes it is the processes that are put into place, because of regulations, that cause mistakes to happen and sometimes mistakes are just that, a mistake. While this doesn’t make it right and is certainly not an excuse, the people working in health care are after all humans.” 

More and more, hospitals – often in partnership with inspectors and surveyors – are looking closely at those processes, looking for opportunities to reduce problems and mistakes. “Over the years surveyors have changed their perspective to a more collaborative team approach,” said Michelle Burford, who manages compliance at Fort Madison Community Hospital.  “In my experience they often welcome questions.  They share suggestions they have learned from other organizations across the country.” 

Though it is enormous, the amount of regulation placed on hospitals is, for the most part, well intended. Most hospitals see its advantages and, in fact, practically all hospitals voluntarily seek other outside assessments that ultimately create more work but also improve health care.  “Mercy has proactively added to the number of survey processes by seeking and achieving accreditations and certifications for many services,” noted Vellinga.  “Mercy wants our patients and communities to understand the extensive efforts under way every day to scrutinize our facilities and services, find opportunities for improvement, and make changes to ensure we do everything right, every time, for every patient.” 

That is the goal of all health care providers – and it should be the goal of those who regulate them.  Just as hospitals examine and re-examine their processes in quest of improvement, hospital regulators should be careful as well, making sure whatever further demands they place on providers are both necessary and effective.