Dr. Judy Paley

Anyone who spends enough time around health care and medicine knows there is no shortage of reading material.  More heavily regulated than the nuclear power industry, the sum of federal, state and local health care policies make the tax code look like a walk in the park.  The 2,400-page health care reform bill? Somewhat impressive, but far from unprecedented.

Outside the regulatory arena, the reading becomes somewhat more interesting. Journals and assorted periodicals cover every specialty.  Health care books could fill a whole aisle or more at Barnes & Noble, and they do.  Many of them are huge tomes by self-indulgent practitioners that leave one immediate impression: When did this guy have time to see patients? 

But there are treasures out there, and one of them is a blog by Judy Paley, a primary care doctor with a two-person practice in Denver.  And the Denver she works in is the one in Colorado, not in northwest Iowa.  That needs to be pointed out, because Dr. Paley sounds and writes like a small-town, patient-centered, community-loving doc.  Her “Medical Moments in 55 Words or Less,” as she calls her blog, have been described as health care haiku.  They are sad, funny, illuminating and the very definition of poignant. 

Give yourself a treat and check out what Dr. Paley so generously shares.

Marty Guthmiller

Martin “Marty” Guthmiller, CEO of Orange City Area Health System (OCAHS), was recently named a finalist for the American Hospital Association’s (AHA) Shirley Ann Munroe Leadership Award, which recognizes the accomplishments of small or rural hospital leaders who have improved health care delivery in their communities through innovative and progressive efforts. 

Given that there are thousands of small and rural hospitals all over the country (and more than 90 in Iowa), this is a great accomplishment that underscores the key role hospitals and their leaders play in their communities. 

Over the last 16 years, Guthmiller has transformed OCAHS, most notably in 2006 when the hospital replaced itself with a beautiful and modern facility.  But just as significant, Guthmiller has been a leader for the community as a whole, including chairing a special task force of the local development board that was convened to revitalize a large swath of downtown Orange City that was destroyed by a 2009 fire.  The “Phoenix Project” won the support of Orange City residents, who supported a $4 million bond issue. 

What Marty Guthmiller has accomplished is outstanding, but it also comes with the territory.  Hospitals, even those in urban areas, are high-profile entities that require leaders with an unusual combination of business acumen and community minded-ness.  It’s no coincidence that hospital leaders are constantly chosen to head up boards and committees for important community organizations and events.  And it follows that those who are especially successful (and based on the press we see here at IHA, many of them are) receive their due recognition, like Marty Guthmiller. 

But it’s more than the CEOs.  The expectations that surround medical care are always high – no other entity, public or private, can begin to take on the roles and responsibilities put upon the local hospital.  Hospital leaders are often the community “face” of their hospitals, but those expectations follow all hospital employees.  Today, the most effective and successful hospitals embrace that kind of culture, where every employee is equally responsible for upholding the hospital’s mission. 

That mission, which in Iowa focuses on patients, the community and service excellence, is at the heart of IHA’s existence and its advocacy.  By providing Iowa’s hospitals with the support, education and information they need to accomplish their goals, IHA advances health care for everyone.

This was not an easy decision for EMH leaders to make.  Only a handful of mental health programs like these exist in Iowa and the services at EMH are heavily used by patients from all over the state.  In fact, only 15 percent of the hospital’s inpatient behavioral health patients come from Hardin County.  This is no surprise; after all, 83 of Iowa’s 99 counties are considered mental health professional shortage areas.  With only about seven practicing psychiatrists for every 100,000 residents, Iowa ranks 47^th in the nation for access to mental health care. 

In Iowa Falls, EMH has done all it could to keep its inpatient program functioning.  The hospital streamlined the program, reduced staff and discontinued its transportation program.  But because of lagging reimbursement, particularly from Medicare and Medicaid, the program has been a drain on overall hospital finances.  This is a problem for all Iowa hospitals offering behavioral health services, but the impact is much greater for small facilities like EMH, which do not have the patient volume to make up for the losses.  This is why only a handful of these small hospitals offer any kind of behavioral health program (inpatient or outpatient). 

The good news for people in and around centrally located Hardin County is that inpatient behavioral health services in Des Moines and Waterloo are relatively close by.  For much of the rest of Iowa, particularly in the western half of the state, the distances are much greater.

What needs to be done?  IHA is advocating for programs that would attract more psychiatrists to the state, such as student loan repayment programs.  Expanding telemedicine services through high-speed Internet would allow more patients to utilitize online counseling rather than having to travel to urban areas where behavioral health programs and practitioners are concentrated.  IHA has been steadfast in pushing to keep the state’s mental health institutes in Cherokee, Clarinda, Independence and Mount Pleasant open – Iowa needs more access to mental health services, not less. 

IHA also continuously advocates for increasing Medicare and Medicaid payments to hospitals and doctors.  Hospitals lose millions of dollars each year because these programs do not cover the full cost of care.

That’s where an important group of highly trained nurses comes in.  Certified registered nurse anesthetists (CRNAs) can perform many of the same procedures as anesthesiologists.  And while there are only about 220 CRNAs in Iowa, they are spread across 64 counties. 

Like anesthesiologists, CRNAs not only provide anesthesia during surgery, they also provide chronic pain management.  This is a critical service, particularly in rural counties that have large populations of senior citizens. Chronic pain can be debilitating and often becomes the defining factor in patients’ lives.  Without relief, or the hope of relief, many patients lose the ability to eat, sleep, work and function normally. 

Imagine being in constant pain and having to travel more than 100 miles or wait more than a month to receive treatment – yet, that would be the situation for many Iowans without the availability of CRNAs. 

Still, there are specialty physician groups that want to create rules that would keep CRNAs from providing pain management.  There is no medical reason for this; Iowa CRNAs have a spotless record of offering this service.  Nonetheless, legislation has been introduced in Iowa that would prohibit this practice by CRNAs. 

Because Iowa’s hospitals recognize the critical role CRNAs play in making sure all Iowans have access to care, IHA opposes this legislation. 

You can find out more about this issue by reading IHA’s position paper.

Hospitals accounted for 5,000 new payroll additions in January, while ambulatory services accounted for 15,000 payroll additions and physicians’ offices accounted for 5,600 payroll additions.  Some areas of the health care sector lost jobs in January; nursing and residential care facilities reported 5,800 payroll reductions. 

The health care sector created 267,000 new jobs in 2009, including 22,000 payroll additions in December, according to BLS data.

Throughout the economic downturn, hospital and health care employment has remained relatively stable. Many Iowans who have lost their jobs have turned to health care to start new careers. This is a smart move; health care offers work that is challenging, rewarding and well-paying.

Many hospitals offer scholarships to help pay for college education in health care.  IHA has its own scholarship program that has helped dozens of Iowans start or advance their hospital careers.

The article also notes that Danny is the first janitor to win the award, which IHA started three years ago.  But several other non-clinical staff have received the award, including a hospital van driver who saved a woman who had collapsed in her home and a groundskeeper who donated a kidney to a co-worker she barely knew.

What all of IHA’s Hospital Heroes have had in common is an uncommon commitment to their work and their communities, and that is clear throughout the profile on Danny:

He can tell you he came to Sioux City in 1966 to work at a laundry, then got a laundry job at St. Luke’s in 1971. By the next year, he advanced to cleaning floors.

Twenty years later, he started cleaning the surgery floor.

“The other guy got caught sleeping,” he said. “They put him in the kitchen.”

Such behavior makes Danny shake his head. He doesn’t like lazy people. Or people that make a mess, he said while cleaning up the lounge.

What’s really gratifying about a story like this is that there are countless people like Danny Harris among Iowa’s 70,000 hospital employees.  That’s why IHA is excited to see who will be nominated as Iowa Hospital Heroes in 2010.

Jo Wagner
Care Coodinator
Cass County Memorial Hospital, Atlantic

For more than 33 years, Jo Wagner has proven herself in many ways and, ultimately, to be a hero at Cass County Memorial Hospital.  First as a home care nurse, then director and finally, for the past 20 years, as a Care Coordinator, she has selflessly committed herself to the care of others.

Her 24/7 availability to patients and families – meeting after hours and on weekends, providing her personal cell phone number – has made an enormous difference in countless lives.  She understands the myriad of medical, financial and personal services available, as well as how to access them. Her expertise varies from arranging nursing home or home care services to accessing financial assistance, to finding care for two children and a dog when grandma was in the hospital after an interstate car accident.

Jo understands the families she is working with are experiencing difficult transitions while trying to maneuver through the sometimes confusing world of medicine.  She has an amazing ability to interpret the medical world in a way families can understand and deal with.  She assists families in making the most difficult decisions when they must.  She does all this with incredible grace and compassion.  Families express their sincere appreciation with their personal thanks, written notes, invitations to family events and special requests to attend funerals.

Jo is also a hero to her co-workers.  For years, she has coordinated a free Christmas store for staff having financial difficulties to “shop” for Christmas gifts.  She has also opened the store to students in the hospital’s behavioral health classroom who need assistance.  How does she know who needs help?  By caring enough to pay attention to those around her, and being the type of person others readily confide in.

The word “hero” often brings to mind an image of a life-saving event.  Jo Wagner has saved countless lives over the years.  Some have been in a traditional clinic sense, helping to heal a body.  Many have been less traditional – saving the quality of life for so many people who just need a little help to get over some of life’s obstacles.

Here are some snapshots of Christmas traditions and events at Iowa hospitals: 

A special visitor at Blank Children's Hospital

Staff members at Blank Children’s Hospital in Des Moines make a special effort to make Christmas as special as possible for the children and families who are inpatient this time of year.  Blank Child Life staff take Santa to visit each patient room – including the neonatal intensive care unit – so each patient can have their photo taken and receive a special gift from the jolly old elf (who, it’s rumored, may be one of the hospital’s pediatricians).  More gifts are distributed, again by Santa, on Christmas Eve.  All gifts given to the children are made possible by generous donations from the community.

At Wright Medical Center in Clarion, each department decorates its area with a designated charity for giving and CEO Steve Simonin and his guitar lead a group of employee carolers throughout the hallways, with employees joining in and harmonizing as departments are visited.  A huge success this year has been an employee holiday assistance fund, supported with bake sales, Clarion Chamber gift certificates, “wow” bucks (given to employees who go above and beyond) and cash donations, with the proceeds all going toward those employees requesting some help for the holidays.  To top it all off, one of the hospital’s physicians, his wife and grandchildren volunteered as “the Santa Claus family” and posed for photos with employees and their families.

At 102, Chris Dekker rings in the holidays in Orange City

Nursing home residents at Orange City Area Health System entertained guests and staff with a bell choir concert.  Traditional Christmas songs literally rang through the hospital’s hallways as residents donned their holiday colors and made a joyful noise.

The “Holiday of Lights” at Greene County Medical Center in Jefferson was a huge success.  People from the community joined staff in decorating trees and wreaths that created a festive atmosphere in the hospital lobby and in the long-term care center.  The decorations were auctioned off, raising nearly $3,000.  At the same time, the hospital’s auxiliary’s homemade candy sales raised another $1,600.  All the money raised will be used to purchase much-needed equipment at the hospital. 

CEO Rick Seidler and a room full of Allen Health System generosity

A food drive by employees at Allen Health System in Waterloo brought in more than 3,000 food items, filling a truck and weighing in at more than 1,000 pounds, for the Cedar Valley Food Bank.

The Broadlawns Medical Center Guild in Des Moines invited all employees to attend the annual Holiday Dinner, which the guild has organized for many years.  This is held in appreciation of the employees’ dedication and service during the past year.  A traditional holiday dinner was served to all three employee shifts by hospital trustees and senior leaders, with CEO Jody Jenner and guild members being the hosts.

In addition to gathering food, clothing and gifts for local families in need and making sure each employee receives a personal gift, staff at Lucas County Health Center in Chariton design, build and drive a float in the town’s annual lighted Christmas parade.  This year’s entry, featuring caroling staff members and their children, won the parade’s People’s Choice Award.  The $50 prize was donated to supplement the hospital’s 2010 First Baby gift basket.

A tree surrounded by giving (and givers) in Osage

A new holiday tradition was started by staff at Mitchell County Regional Health Center in Osage.  Recognizing that struggling children and families were being well served by other local organizations, the hospital initiated its first Angel Tree for needy adults.  The hospital contacted nursing homes, care facilities and public health to get descriptions of people who had a need and those were shared as Christmas tree angels in the hospital lobby.  Within 24 hours, all of the angels were gone and two weeks later the gifts were at the hospital, where they were wrapped by department managers and then delivered.

Preparing to feed the masses in Atlantic

Individual departments at Cass County Health System (CCHS) in Atlantic organize activities to brighten Christmas throughout the community.  Donations to the local food pantry, adopting families and children, donating items for a “Santa’s Closet” shopping room for staff who may have a hard time purchasing gifts, creating a beautiful hand-made quilt to raffle to adopt a family – there is no shortage of generosity and caring spirit!  After hearing that coats, warm clothing and blankets were in short supply at an Omaha mission, CCHS employees filled a pick-up and car full of donations in just 24 hours.  An annual health system-wide tradition is the Holiday Meal, served to people in the community who are unable to provide their own special dinner.  Staff donate time by serving meals; talent by bringing homemade baked goods for “to-go” packages; and treasures by giving financially to offset the cost of the meal and gifts for each family.  This will be the 12^th year for this very special event, which provides a delicious holiday meal for about 130 people every year. 

Employees load gifts for needy families in Primghar

Each year, staff at Baum Harmon Mercy Hospital and Clinics in Primghar, Paullina, Sutherland and Hartley participate in the Adopt a Family Program.  The hospital and clinics adopted seven families this year.  Each family receives a grocery gift card paid for by monies donated from staff for “blue jean Fridays.”  The staff bought gifts for the children including a bicycle, games and clothes.  Everyone brings extra groceries to go with the grocery gift cards and some purchased additional gift cards to be given to the families.  In addition to the formal Adopt a Family program, some staff made gift baskets for needy families we serve in our clinics.  This was done in-lieu of staff exchanging gifts amongst themselves.

Algona carolers bring songs and smiles

Kossuth Regional Health Center in Algona has a tradition of gathering staff to carol over their lunch hour to patients and other staff members.  Staff usually do this one of the last days of the work week before Christmas and many employees dress the part with Santa hats, reindeer ears and so on.

At Great River Medical Center in West Burlington, chaplains from the Spiritual Care Department deliver poinsettias to all inpatients on Christmas Eve. The plants are purchased by Great River Friends, which is a combination of former auxiliary members and the hospital’s Volunteer Services Department.

After dinner, a special photo in Dubuque

Partnering with the Visiting Nurses Association, employees at The Finley Hospital in Dubuque provided a full holiday dinner and gifts for 34 local families, including more than 50 children.  The VNA and Finley Hospital employees donated hundreds of hours and collected nearly $5,000 to support a Community Outreach Holiday Meal. This hospital-wide effort at Finley raised funds for gift cards for the families by holding wreath and mini-tree sales, paying to wear jeans on a given Friday, bake sales, pass-the-hat collections and payroll deduction.

Continuing to spread the pride and joy that goes with a new community hospital, Jefferson County Health Center in Fairfield will have an afternoon of music (provided by a local high school musician who has been a member of the All-State Orchestra for two years) and refreshments for all hospital visitors.

Beautiful music on a winter day in Storm Lake

Music also fills the air at Buena Vista Regional Medical Center in Storm Lake when members of the local symphony (including one of the hospital’s physicians) put on a lunch-time Christmas concert.  This is a hospital tradition that draws a big crowd every year.

Young singers regale staff and visitors at Waverly Health Center.  A choir from nearby Southeast Elementary stops by the hospital each year to share carols and that special Christmas spirit that comes from young voices and hearts.

Here at IHA, staff donated gifts and cash to make Christmas happen for 16 individuals (including 11 children) in three needy families.  The families were identified for IHA by counselors at Des Moines’ George Washington Carver Elementary, a neighborhood school that IHA has supported for several years with the Christmas gift project, school supply drives and during the United Way Day of Caring.

Ringgold County Hospital will open in its new facility on December 20. The hospital replaces a building that was built nearly 60 years ago.

The new facility will provide many advantages compared to the old hospital, which was built in 1951. One of the most important aspects of the new building is the efficiency of space. The new medical complex is 61,000 square feet, a vast improvement over the old, land-locked hospital with 38,000 square feet.  With the additional space, many of the medical areas and services will become more departmentalized.

The new one-level facility will also have two entrances. The south entrance will be for patients, visitors and employees, the north is for delivery and ambulance services. The helipad will be in its own area on the north side of the building. This will eliminate the problem of re-routing traffic and parking that existed at the old facility, where he helipad is in the center of the parking lot.

Other new additions patients can expect to see will be 16 private patient rooms and seven dialysis stations. With the seven dialysis stations, it will ease the problem at the old facility of patients having to start dialysis treatment at 4:30 a.m.so everyone can get through. There will also be radiant heating panels above each station.

Construction on the new hospital began in October 2008.

Ringgold County Hospital employs more than 120 people and has a $7.2 million impact on the area.

There is no bigger hero at Wright Medical Center than Amy McDaniel, the hospital’s Chief Financial Officer.  Typically, you don’t look to the CFO to be a hospital hero, but not every CFO is like Amy. 

Amy is patient and welcoming, and is always willing to listen and encourage anyone.  She does her job very well and is the picture of professionalism even in these challenging economic times.  She always has a calming positive outlook, is able to look at the big picture, and is very direct and honest in her approach.  In addition, she is a senior leader and manages several departments as parts of the hospital’s “Finance Pillar.”  The pillar she chairs receives all the employee cost-saving ideas.  Those recommendations are then translated into a dollar saving potential and passed on to the departments to implement.

Throughout the years, Amy has helped to grow and lead Wright Medical Center in ways that most small rural hospitals are not accustomed to.  Wright Medical Center has enjoyed phenomenal growth and success and a large part of this is due to Amy’s ability to think very much out of the box.  She tirelessly sought out financing models, grants and ways around conventional ways of thinking that did not move the hospital forward.

Amy also has a busy personal life with a police officer husband and four children.  A daughter, twin boys another girl and a couple of big dogs make their family complete.

Amy is the model of Wright Medical Center’s culture and values.  Every day, she illustrates and mentors what we can all accomplish together with the right attitude. 

The hospital is proud of the “Hospital Hero” that Amy McDaniel truly is.  Because if there really is a “Wonder Woman,” she is working as the CFO at Wright Medical Center!