Cover Story
2006 Foster G. McGaw Prize Winner
By Terese Hudson Thrall
Memorial Healthcare System, Hollywood, Fla.
Although nestled along South Florida’s Gold Coast, with its many posh waterfront communities, southern Broward County has its share of residents who struggle every day with a variety of needs. Memorial Healthcare System, Hollywood, reaches out to a market of some 635,000 people—18 percent of whom are uninsured—with myriad programs that transcend traditional notions of a hospital’s role. “Having a healthy community goes beyond medical care,” says Frank Sacco, Memorial’s president and CEO. “It goes to quality of life.” Memorial’s quality-of-life commitment includes support for everything from improving local public housing to ensuring prenatal care for uninsured mothers-to-be.
In recognition, Memorial Healthcare is the winner of the 2006 Foster G. McGaw Prize for excellence in community service. The $100,000 award is sponsored by the American Hospital Association, Baxter International Foundation and Cardinal Health Foundation.
One vivid result of Memorial’s broad definition of a healthy community was the installation of air conditioning in a public housing project. Memorial worked with local officials and others to identify the need for and find the means to get the units in place after surveys of residents found that the lack of air conditioning had implications beyond simply comfort.
“Why are the kids outside at 9 p.m. and not inside studying?” asks John Benz, Memorial’s chief strategic officer and senior vice president. “If it were 90 degrees, would you be in your house? If the kids were inside the house, would they be effective students? The answers were no, no and hell no.”
LaTonya Williams, a working single mother of two who lives at the 100-unit housing project in Davie, Fla., says she and her daughters made it through sticky Florida summers by staying out of their apartment in the daytime and using fans at night. “The fans were so noisy it was hard to sleep,” she says. “The air conditioning made a tremendous difference.”
Davie’s Driftwood neighborhood is just one place where Memorial has made a difference. Since 1994, the system has conducted 10 Community Empowerment Programs. Sharing the costs with a partner—usually the local municipality—Memorial hires a full-time neighborhood coordinator. During the first six months, the partners identify needs; during the next six months, they find resources to meet the needs; and during the last six months, they educate community stakeholders, preparing them to continue leading the projects.
“We want to show them we can make a difference in 18 months,” says Steve Sampier, director of community services at Memorial. “In the early meetings with residents and Davie officials, they really started thinking big.”
Big thinking has brought big results. Over the last seven years, public housing units in the Driftwood neighborhood have undergone cleanup and improvements, Habitat for Humanity has built 22 homes, and a $1.3 million Boys & Girls Club opened.
Williams says her 13-year-old and 16-year-old daughters take full advantage of the the 8,000-square-foot Boys & Girls Club, complete with a computer lab and game room with billiard and pingpong tables. The facility, which opened last year, was paid for with federal and county funds. “For a working parent, it’s peace of mind,” Williams says. “I know my kids are there and not getting into mischief.”
Improvements to community life are spurring other changes.
“It’s gotten so attractive here, private development is coming in,” Sampier says on a drive through Driftwood, pointing out town houses now under construction.
Memorial representatives say a key to such success is giving residents the tools to make and demand changes. “We’ve helped develop homeowners’ associations and empowered communities to stick up for their rights,” Sacco says. “With the help of law enforcement and government agencies, we have given parks back to children from drug dealers.”
Another key is finding partners and outside funding sources.
Davie officials had already targeted the Driftwood neighborhood for improvement, and they used Memorial’s staff and survey information to focus those efforts. When Memorial’s survey of Driftwood residents showed the need for public housing air conditioning, for example, the town was able to access Community Development Block Grants to fund it.
Memorial does its own share of finding funds; its staff of three grant writers bring in about $10 million a year for various projects. But Memorial has learned that it doesn’t have to spearhead every community improvement project.
“If someone out there is already doing it, ask them how you can help,” Benz says. “If someone is out there not doing it well, ask how you can make it better. If there’s nothing out there, lead.”
Helping the Uninsured
Memorial has taken the lead in providing health care to the uninsured. In the early 1990s, it took over providing health care for uninsured children and expectant mothers from the state, and for poor adults from the county.
“It was a fractured system,” Sacco explains. Expectant mothers often had received no prenatal care until their seventh month because they could not get an appointment. “That was unacceptable,” Sacco says. “When you start prenatal care in the seventh month, you can’t work on smoking cessation, nutrition, drug or alcohol programs.”
Today, 98 percent of the mothers delivering in Memorial’s system have received prenatal care for their entire pregnancies, up from about 20 percent when the state was in charge, Sacco says. Memorial’s primary care system now has three clinics, a $22 million annual budget and provides 100,000 visits a year. Half of the primary care patients are uninsured.
Memorial’s efforts extend beyond the hospital and clinic walls. Once a week during the horse-racing season, the system sends a doctor and a medical assistant to nearby Gulfstream Park to treat migrant workers from Central and South America who train and groom horses. The program, largely underwritten by a federal grant for the care of homeless people, treats 50 to 100 people a year, and Memorial is striving to reach a bigger proportion of the 800 to 1,000 migrant workers at the park.
“Preventive care is foreign to them,” explains Rochelle Ayala, M.D., administrator and chief medical officer of primary care services. “They think about going to the doctor only if they are really sick.” Next year, Ayala plans to send the system’s adult mobile van to the park to educate and screen more workers and identify conditions before symptoms occur.
Finding the Funds
The Memorial system will spend $140 million this year on inpatient and outpatient uncompensated care, with 60 percent of that total going to charity care and the remainder to bad debt.
Although a public, not-for-profit hospital system, Memorial receives only a small amount of tax assistance—5 percent of its annual $1.2 billion annual operating budget. The system, which maintains an annual margin of 5 percent to 7.5 percent, is able to foot the bill for charity care by being the area’s provider of choice, Sacco explains.
The five-hospital system includes Joe DiMaggio Children’s Hospital, which draws patients from six counties, and Memorial’s cancer, cardiology and neurosurgery programs attract patients from outside the catchment area.
Sacco believes Memorial’s care should extend to everyone in the hospital’s district, regardless of their insurance coverage. The system spends $8 million annually to reimburse specialists and other doctors outside Memorial’s clinic system for uninsured patients. “If you are going to come to Memorial, we want to do the best job possible,” he says, “so uninsured patients see the same specialists that I do.”
Care Management with a Personal Touch
The system’s disease management program provides the same level of service to uninsured patients as those with insurance. About 1,000 patients are in the program at any one time; most have diabetes, although patients with asthma, hypertension, HIV and congestive heart failure can also participate. Nine nurses coordinate patients’ care, making sure those patients go to their doctors’ appointments and receive and understand medications.
“My care manager is an ace,” says Steven Bilodeau, a congestive heart failure patient. “She’s my go-between and gets everybody on the same page.” He credits care manager Maria Ricardo, R.N., with getting him into Memorial’s cardiac rehabilitation program.
“She calls to check on me,” says the 40-year-old Bilodeau. “She takes care of me like I was her own son.” The program’s results are significant. For instance, over a three-year period, the number of diabetes participants with blood sugar levels under control increased by 32 percent, and the number of patients with severely high blood sugar dropped by 48 percent. By having nurses keep track of patient interventions that directly averted emergency department visits, Memorial officials estimate that the program prevents dozens of emergency visits every year. But the nurses do more than manage care. They are well-versed on where to refer people who need assistance with housing or utility bills, purchasing medications or food and clothing.
Focusing on the Young
A number of Memorial’s programs focus on children and teens, the result of a community needs assessment that revealed gaps in services for that population. “The area had a lot of juvenile crime, school dropouts and truancy,” Sacco says. “We wanted to know what we could do to solve those problems.”
The Community Youth Services department, launched in 1999, currently serves 3,000 youths and their families, encompassing 16 programs and nearly 100 Memorial employees. The programs address a wide range of topics for at-risk youth, such as pregnancy and substance-abuse prevention, self-esteem and parenting education. Its $4.6 million annual budget is largely funded through grants.
Among the offerings are free after-school programs and summer day camps at eight schools, designed to keep kids busy during peak times for juvenile crime. Children receive snacks, physical fitness and structured education time. On a recent afternoon, a single mother picking up her 6-year-old stopped to thank the staff at the Davie community center. “God bless you,” she said. “I don’t know what I would do without you.”
The same sentiment is often expressed by parents at the Therapeutic Afterschool Program, says Edd Ross, a behavior specialist. The free program cares for children and adolescents who are severely mentally challenged or emotionally disturbed. “They tell me we are their lifesavers,” Ross says. He notes that the after-school care is a boon for working parents and that the staff takes youngsters on field trips their parents might shy away from. “When we told them we were taking them on airboats, the parents said, ‘Oh no,’ but we did it,” says Ross, with a smile.
Pamela Tiger says her 21-year-old autistic son Daniel has become more verbal and animated in the three years he’s been in the program. Before, Daniel would spend his time after school in his room, playing with toy cars and watching television. Now he’s outside playing catch, or working on puzzles and sorting tasks to help his development. “Danny loves it,” she says.
For Andrew Gregoire, one of the youth services programs presented him with a second chance. After committing a minor offense in 2001, Gregoire was given a choice of going to court or receiving counseling through New Directions, a 12-week program for first-time, nonviolent offenders. Now a 22-year-old junior at Miami’s Florida International University, Gregoire says the counseling changed his life. “My counselor gave me a pathway to shape my future,” he says. “Without it, I would have made more bad decisions.” He also began volunteering at one of Memorial’s after-school programs, and he is now a paid counselor. “I really enjoy making a difference in kids’ lives,” Gregoire says. “Even if I can help only a few, that’s significant.”
Benz, who oversees the community service programs, agrees. “The problems we deal with are huge, and a lot of organizations never get started addressing them because of the size of the problems. But we’ve found we can make a difference, day by day.”
As complex as the problems are, the goal is straightforward, says Memorial Healthcare’s president and CEO. “The aim of all we do is to create a healthier community,” Sacco says. “We want to make a better place to live.”
Terese Hudson Thrall is senior writer for Hospitals & Health Networks (H&HN). This article originally appeared in H&HN’s April issue.
The 2006 Foster G. McGaw finalists
Baystate Health in Springfield, Mass.
Montefiore Medical Center in the Bronx, N.Y.
Sisters of Charity Health System in Lewiston, Maine
Each finalist will receive a $10,000 prize.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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