At the recent American Hospital Association Health Forum Rural Healthcare Leadership Conference in Phoenix, hospital leaders delivered a strong message to Congress urging it to protect community-based health care. Congress recently introduced several bills addressing rural hospitals and hospital leaders are urging support for rural policies. Two Iowa hospital CEOs attending the conference shared their perspective on these important issues:
Mike Myers, CEO of Veterans Memorial Hospital in Waukon:
Todd Linden, CEO of Grinnell Regional Health Center
(From time to time, the blog features recipients of the IHA Iowa Hospital Heroes Award. These outstanding hospital employees come from across the state and work at hospitals of every size. They exemplify the courage, caring and community focus that are at the center of the hospital mission in Iowa.)
How do you put into words the impact this Hospital Hero has made over her 40-plus years of dedication to health care? How do you describe someone who at Christmas, makes up big batches of different kinds of soups, divides it up in small containers and delivers it to elderly people in the community, but is also recognized as one of the outstanding nurses and leaders in the state of Iowa?
JoAnn Lampe currently holds the position of chief nursing officer and safety/compliance/risk manager at Fort Madison Community Hospital (FMCH) but has developed and held multiple positions. In 2010 she was recognized by the Iowa Organization of Nurse Leaders with the Outstanding Nurse Executive Award. But it is not the title she holds or the accolades she’s received that make her a Hospital Hero, it is that lasting impression she makes in each person’s life that she touches. Here are just a few examples:
“I have observed JoAnn display a kind, heartfelt touch or hug to so many people that truly just needed to feel that connection with someone who cares.”
“When my Dad was very ill and in the hospital, she took the time out of her busy day to stop in to see him. My Dad was very anxious and scared. JoAnn knew exactly what to say to calm him down. They cried and prayed together.”
“She has gone to patients homes after they are discharged to assure they continue to follow their care regimen; sitting with them so their families have some time to themselves.”
“She always knew what was going on with every patient, the right questions to ask the physicians, and the right tasks to do to help heal.”
“The amazing things that JoAnn does on a day-to-day basis are just a part of who she is and are no longer viewed as unique.”
“I don’t remember a thing she said, but I remember how she made me feel. She was a nurse who cared so deeply about taking care of people; I thought that if this is the way people are here, I want to be a part of it.”
JoAnn is a hand holder, a sincere smile, a get’er done kind of Hospital Hero who indeed contributes courageously and selflessly to FMCH and our community.
It’s been more than 15 years since the Institute of Medicine released its seminal 1997 report detailing the suffering many Americans experience at the end of life and offering sweeping recommendations on how to improve care.
So has dying in America gotten any less painful?
Despite efforts to build hospice and palliative care programs across the country, the answer seems to be a resounding no. The number of Americans experiencing pain in the last year of life actually increased by nearly 12 percent between 1998 and 2010, according to a study published in the Annals of Internal Medicine. In addition, depression in the last year of life increased by more than 26 percent.
That’s the case even though guidelines and quality measures for end-of-life care were developed, the number of palliative care programs rose and hospice use doubled between 2000 and 2009.
“We’ve put a lot of work into this and it’s not yielding what we thought it should be yielding. So what do we do now?” asked study author Dr. Joanne Lynn, who directs the Center for Elder Care and Advanced Illness at the Altarum Institute.
The study looked at 7,204 patients who died while enrolled in the national Health and Retirement study, a survey of Americans over age 50. After each participant’s death, a family member was asked questions about the person’s end-of-life experience, including whether the person suffered pain, depression or periodic confusion. Those three symptoms were all found to have become more prevalent over the 10-year analysis.
One reason, Lynn said, is that doctors are using a greater range of high-tech treatments, which can lengthen the process of dying without curing the patient. “We throw more medical treatment at patients who are on their way to dying, which keeps them in a difficult situation for much, much longer,” she said. “We’ve increased the number of people put on ventilators and kept in hospitals, and we simply have more treatments that are possible to offer.”
The majority of our research, she added, focuses on wiping out diseases, rather than long-term supports or symptom management for people with chronic conditions or disabilities associated with aging: “Think about how much we invest in curing Alzheimer’s disease, and how little we put into making the course of Alzheimer’s better.”
Most physicians tend to under-treat pain and other symptoms at the end of life because they don’t recognize them or are hesitant to talk candidly about the process of dying and the pain associated with it, said Dr. Tim Ihrig, a palliative care physician at UnityPoint Health in Fort Dodge, Iowa.
“A lot of practitioners aren’t honest. We fail to empower patients with the truth,” said Ihrig. “In that setting, it’s easier to continue to do procedures and diagnostics rather than having that conversation, which is very honest and very difficult.”
Take a cancer patient who has stopped eating and is writhing in pain, he said. An oncologist might recognize the person is going to die, but rather than telling the patient, he or she begins another round of treatment that causes more pain and suffering.
“We don’t have the vernacular in our society to have the conversation about the end of life. People say, ‘I don’t want to take away someone’s hope.’ But in a metastatic pancreatic cancer, for example, we have to redefine what we mean by hope,” he said, citing one of the most deadly cancers.
Often, those conversations aren’t happening until the last days or hours of life, according to Ihrig.
Jonathan Keyserling, a senior vice president with the National Hospice and Palliative Care Organization, points out that half of all hospice patients receive hospice care for less than 30 days.
“If these patients had been under the care of a hospice or palliative care program [earlier], their pain and symptoms could have been brought under control for a much longer and sustained period of time,” Keyserling said via email.
It’s possible, however, that caregivers interviewed in the study simply reported more suffering, reflecting Americans’ changing awareness of pain and depression over the past decade.
“We’ve raised the expectation of better pain management over the years, which may make [the caregivers interviewed] more likely to report it,” says Rosemary Gibson, author of The Treatment Trap and senior advisor at The Hastings Center, a bioethics think tank based in New York. There are many more Americans diagnosed with depression today than in 1998, she added, “so it’s not surprising that people would report it more.”
Nonetheless, Gibson said, the country has a long way to go in improving care at the end of life. The increase in palliative care and hospice use over the last decade was just ”an oasis in the desert. We did nothing to stop the tsunami of overuse [of aggressive treatments] and doing things to people at the end of life that have no benefit.”
It’s time to pick up the speed of change, said study author Joann Lynn.
“We are all going to pass through this part of our lives, and we have a strong interest in its not being awful. So let’s buckle down and get it right.”
In any community, a hospital is a unique institution. Even in cities with multiple hospitals, each has its own history, mission and culture. One way that uniqueness is reflected is in art.
“There is a growing body of research that shows that our emotions, behaviors, thinking and even our health is influenced by our physical environment,” explained TJ Moberg, owner of Moberg Gallery in Des Moines, which has worked with several Iowa hospitals in planning for and selecting art. “Hospital design teams are taking every part of the hospital interior and exterior design into account and making decisions that will influence better health for their patients through better design.”
As he works with hospitals on art design, Moberg’s goal is to move well beyond decorating to help hospitals use art in ways that are thoughtful, inspirational and therapeutic.
“Placing art in hospitals is an opportunity to serve patients and visitors by taking art back to its most fundamental roots, when art was used to represent people and culture and thus becomes more personal and practical,” Moberg explained.
That was the case at Mahaska Health Partnership (MHP) in Oskaloosa, where Moberg helped design a donor wall at the Hospice Serenity House in 2010 as well as art for a new patient care wing in 2013 that included providing artwork in seven major areas of the hospital.
“TJ brought us themes and recommendations for those areas and we had the opportunity to choose the theme we felt best suited our organization,” explained MHP CEO Jay Christensen. “Then, TJ selected artists who fit our theme and presented what they recommended for those areas and what the cost would be.”
The results and response from the community have been very gratifying, Christensen said. “We selected artwork that relates back to Mahaska County landmarks and ties us back to the community. It really does give our facility a home-like feel and the community response has been extremely positive.”
At Cass County Health System (CCHS) in Atlantic, Moberg’s input on the hospital’s new chapel led to a return engagement for a hospital-wide project. Once again, the unique flavor and scenery of the area was critical to the design even while the focus was, as always, on healing.
“We believe that healing involves more than just repairing broken bones or bandaging wounds,” explained Dawn Marnin, CCHS foundation director who worked closely with Moberg. “It also involves the mind and spirit, which is why this art project is so important.
“The communities we serve have embraced the art and understand the motivation is to aid in the healing process and relieve stress,” Marnin said, pointing out that the art draws patients out of their rooms and even brings them back to the hospital. “We have patients who will come back with their family members just to show them the pieces we have and to share stories of what the artwork reminds them of and how it affected them.”
Christensen agreed. “The artwork took MHP from being a nice facility where people get great medical care to a true feeling of ‘my home for medical care.’ It really has helped us connect with the community. It is the ‘wow’ factor that resonates with people long after their time with us.”
Partnering with the hospitals has been a positive and often moving experience for Moberg. “When we are working on site preforming an installation, we get to see how patients, family and staff react to the art and how it really seems to change their mood. They laugh, smile and tell a story and are temporarily transported from the interior of a hospital into the art. That’s how art serves a higher purpose than just decoration.”
IHA, Iowa hospitals and the state’s nursing community lost a Hospital Hero last week. Gail Meyer, who retired as IHA’s vice president of nursing and patient services in 2006, passed away January 25.
Gail was a leader, mentor, co-worker and friend who built her professional career and personal life on the values of connecting, collaborating and caring.
In a nursing career that spanned nearly 50 years, Gail gave tirelessly to the profession she entered as a staff nurse and rising up to move into nursing administration before finding another avenue to further quality health care through IHA, where she served Iowa hospitals for 22 years. It was evident in her daily approach to work and life that Gail truly enjoyed what she did, which was effectively promoting nurses and the nursing profession to support high-quality care for patients and families.
She was a connector. Gail served as the liaison to multiple personal nursing groups with the Iowa Organization of Nurse Leaders at the forefront. She was the go-to person for nurse leaders across the state as well as in state agencies. She pulled from her clinical and administrative experience and when she didn’t know the answer, she’d draw upon her extensive network of professional contacts. And it wasn’t through e-mail; she’d pick up the phone, set up a meeting and in short order she had the necessary information or solution.
Gail’s professional relationships at every level of health care within Iowa and around the country served Iowa nurses as she kept them informed on current policy and practice issues as well as aware of changes coming beyond the horizon. She felt a profound responsibility to keep Iowa nurses ahead of the rest and took pride that Iowa hospitals were well known for quality patient care. Gail was a nurse’s nurse.
She was a collaborator. When regulations or operational issues challenged patient care issues, Gail made sure that nurses had a place at the table. Her advocacy was always focused on what was best for patients, with the unbending goal of helping nurses to provide the highest quality care possible. And it was her collaborative style that set her apart and often laid the path for advancing an issue whether with nurses, regulators, lawmakers or hospital administrators.
Gail cared about people. Packed inside her pocket-sized frame and coiffed hair was a passion for serving people. She started the neonatal intensive care unit at Mercy Medical Center-Des Moines. She started an IHA initiative to promote health care careers in high schools. Fifteen years ago with fears of a growing nurse shortage, Gail was instrumental in creating the highly successful and respected IHA Health Care Leadership Series to support the professional development of clinical staff as effective leaders and retain valued staff. She grew the reputation of Nurse Day and recognition of nurse leaders at the IHA Annual Meeting as the meeting not to be missed.
Gail loved the IHA Annual Meeting; she was there last October celebrating with friends and former co-workers at the conference’s sprawling new venue. Her smile was extra wide during Annual Meeting. It was like a nursing reunion and she loved hosting it and getting reconnected with everyone from everywhere.
Gail was a connector. Gail was a collaborator. These skills and abilities were key to her effectiveness and success as a nurse, leader, advocate and friend. At her core she was a compassionate person; it was Gail’s passion for caring for people that made her work a joy rather than a job — and what so many of us who knew her and worked with her treasured about Gail.