2006 Nova Awards
By Dagmara Scalise
Collaboration, passion, goal-setting, mission and outreach. Those are some of the traits shared by the winners of the 2006 NOVA Awards, sponsored by the American Hospital Association and Hospitals & Health Networks. Whether their projects targeted children with asthma, those whose working parents cannot afford health insurance but do not qualify for federal aid, the uninsured, immigrants or the elderly poor, these hospitals and their community partners are driven by the belief that it is their place and their mission to improve health care for everyone.
“The best way to ensure the hospital’s future in the community is to be intertwined with the community, so they can’t conceive of it without you,” says Jim Foy, president and CEO of St. John’s Riverside Hospital, Yonkers, N.Y. Working together, with a well-defined goal, the 2006 NOVA Award winners overcame daunting obstacles to make real differences to patients.
ProHealth Care Community Health Outreach Initiative
ProHealth Care, Waukesha, Wis.
Parish Nurses Target the Underserved
Helping underserved patients is at the heart of the ProHealth Care Community Health Outreach Initiative. Over the last decade, providers affiliated with ProHealth Care, a southeastern Wisconsin system that includes Waukesha Memorial and Oconomowoc Memorial hospitals and 13 primary care clinics, have worked with churches, schools and social services agencies to develop a wide network of health care services that target the uninsured, the elderly, the poor and those with language and culture barriers.
The centerpiece of the initiative is the Parish and Community Health Outreach Nursing Program, launched by Waukesha Memorial Hospital in 1995. Nurses work in community organizations to provide health screenings and immunizations, educate patients and serve as advocates. Some of the patients, such as those with chronic conditions, are seen regularly. For some patients, it is the only health care they receive.
At its inception, two nurses were assigned to work in parishes in the community; today, 19 nurses work at 41 community sites.
The Parish Nursing Program not only provides reliable access to health care to the underserved, it also gives back to the community, says Debbie Ziebart, director of community benefits outreach at ProHealth Care. “We all quickly realized the strength community building brings to a congregation,” she says.
In 1999, Waukesha Memorial Hospital was one of four partners to launch the Hispanic Health Initiative to better serve the area’s growing Hispanic population. That effort steadily expanded and now includes such diverse programs as the Hispanic Breast and Cervical Cancer Outreach Program, developed by Oconomowoc Memorial Hospital; the Lake Area Free Clinic, established by physicians and administrative staff of Oconomowoc Memorial; and the Hispanic Community Health Resource Center to promote health and reduce barriers to getting care for Hispanics.
The health system’s commitment to underserved patients was initially greeted with skepticism by some community organizations, says Gary Buerstatte, senior vice president, strategic planning at ProHealth Care. “When we went to some agencies to move efforts forward, occasionally we’d have people lean back and say, ‘What’s in it for you?’” he recalls. “Health care is a big business and there’s a feeling there has to be some ulterior motive. But our response has always been, ‘It’s purely a matter of mission.’ Once we explained that, then they’d lean forward and say, ‘Tell me more.’”
Rexford “Ford” W. Titus III, ProHealth Care’s president and CEO, says that many communities believe their hospitals are for-profit, big business even though they’re not. “Community benefit is one way we can demonstrate our commitment,” he says. “Your value is only as great as the communities you serve perceive you.”
Saint Joseph Mobile Health Services
Saint Joseph HealthCare Inc., Lexington, Ky.
Taking Care on the Road
Many people in Fayette County, Ky., don’t have the means or the ability to readily access health care. Thirteen percent of residents are uninsured—a number that climbs the closer one gets to Appalachia—and lack of transportation is a serious issue.
So in 1997, Saint Joseph HealthCare Inc. in Lexington established the area’s first and only primary care clinic on wheels. Housed in a 40-foot-long motorcoach, the Saint Joseph Mobile Health Services travels to five locations in the community, providing primary care, health promotion and disease prevention, as well as education and counseling to underserved patients. Saint Joseph HealthCare provides approximately $500,000 annually to support the mobile clinic. A core staff made up of a nurse practitioner, medical director, social worker and driver travels to a set location every weekday. On any given day, the Mobile Health Services serve approximately 14 patients.
Initially, organizers thought they’d be providing mostly acute care, for such ailments as the flu and sore throats, but they quickly discovered primary care was the greatest need. “We saw 30- and 40-year-olds with conditions normally seen in 60- and 70-year-olds,” says Rose Rexroat, R.N., director of community benefits. “That’s the impact of disease and not having adequate medication.”
Recruiting specialty physicians quickly became a priority. Today, four specialty physicians—a cardiologist, a rheumatologist, an endocrinologist and a pediatrician—work with Mobile Health Services and another 50 to 60 physicians work with patients during office hours.
One major component of the service is providing free medications. In the last year, the mobile service obtained more than $2.2 million in free medications from pharmaceutical companies.
Residents’ isolation brings added value to the Mobile Health Services, says Saint Joseph’s CEO Eugene Woods. For many, the service not only provides access to health care, but is also a social network. “The program is a vivid expression of who we are,” he says. “It’s our mission. And the test of that mission is in the eyes of [our] associates. You can see the passion in the associates who do this work.”
The impact of the Mobile Health Services has been so significant that in 2002, two eastern Kentucky legislators initiated legislation to create the Eastern Kentucky Mobile Health Services.
Known as the EKyMHS, it is directly modeled on the Saint Joseph experience, in which providers visit five extremely rural Appalachian communities each week to provide primary care and referrals to specialists.
“A big part of the Mobile Health Services is that it says to the poor, ‘Our doors are open. You’ll receive the same kind of care as other patients,’” Rexroat says. “These outreach programs have a correlation with how people are treated.”
Healthy Learners
Sisters of Charity Providence Hospitals, Columbia, S.C.; McLeod Medical Center, Dillon, S.C.; Allendale County Hospital, Fairfax, S.C.; Self Regional Healthcare, Greenwood, S.C.
Covering a Vulnerable Demographic
Children can’t learn if they have health problems, if their poor vision prevents them from seeing the blackboard or if hearing loss hinders their ability to hear and absorb information. But many parents, especially the working poor, can’t afford health insurance and can’t afford to take time off from their jobs to take their children to the doctor.
That’s where Healthy Learners comes in. The program, created in 1992 by the Sisters of Charity Providence Hospitals, Columbia, S.C., targets the health needs of children whose parents earn too much to qualify for federal aid but who don’t have the financial wherewithal to access all the care their kids may need. It’s a group that often falls through the cracks of health care systems, says Dee Dee Chewning, former executive director of the Healthy Learners program.
The staff at Healthy Learners works with seven school districts in five South Carolina counties to identify children in need. Those children are then guaranteed to receive care. Healthy Learners’ staff members arrange medical and dental appointments for the children, transport them and accompany them to their appointments. The program absorbs all the costs for medical care and also provides health education, such as dental hygiene information, asthma and allergy prevention and care, and nutritional information.
Although vision and dental care, both of which require episodic treatment, are the most common reasons children are referred to Healthy Learners, the number of children with chronic conditions who require multiple medical appointments is growing.
Healthy Learners’ other great benefit is that it covers prescription drugs for any child whose parents cannot afford them. “Chronic conditions ... can get very expensive, so all the child has to do is show up with a valid prescription and we pay for it,” Chewning says.
Healthy Learners clears the way for children to thrive in school. “We’ve been able to remove a barrier to learning,” says Sisters of Charity Providence Hospitals’ CEO Steven Purves, who sits on Healthy Learners’ advisory board. “Those formative years have everything to do with that child being a productive citizen. It’s also an expression of our mission to educate, to meet our communities’ health care needs and to provide access to health care.”
The program relies on scores of partners in the community to provide health care services and financial support and has garnered a lot of attention for its efforts, including a recent award from the Catholic Health Association, Purves says. But it faces ongoing challenges. “It’s one thing to get seed funding, but it’s another to find funds that will sustain the program,” he says. “To succeed, you can’t go into it with an attitude of ‘If we get funding, we will do this.’ Instead, you have to think, ‘Because we’re going to do this, it’s imperative to get funding.’ It starts with a passion.”
Yonkers Childhood Health Initiative
St. John’s Riverside Hospital, Yonkers, N.Y.
A Tragedy Fuels a Mission
The death of a 9-year-old boy from an asthma attack at a Yonkers, N.Y., school in 1998 galvanized leaders at St. John’s Riverside Hospital and the Yonkers public school system. They organized the Yonkers Childhood Health Initiative (YCHI), which addresses not only asthma, but also obesity and immunizations among schoolchildren.
St. John’s Riverside Hospital donated asthma treatment equipment, such as compressors and disposable mini-nebulizers, to 55 schools and trained school nurses to treat students.
The benefits are twofold. “This isn’t just a health care program, it has an educational impact,” says St. John’s CEO Jim Foy, who commissioned the YCHI. “It can keep kids in school.” Before the program launched, asthmatic youngsters frequently missed school. Now, nearly 95 percent of students treated for asthma return to class and trips to the emergency department have dropped significantly.
In 2000, the School-Based Asthma Program was created, expanding asthma education. A year later, a social worker came on board to assist families in obtaining treatment orders, arranging appointments for children with the St. John’s Riverside Asthma Medication Center and helping to address medication use, insurance and other health and family issues.
The success of the asthma program encouraged the hospital and the YCHI to tackle other significant childhood health issues, in particular obesity and school immunizations.
St. John’s Riverside created “Just for Kids,” a classroom-based education program for first- and second-graders that incorporates exercise with lessons about appropriate food and homework assignments about obesity. Children are given pedometers and teachers encourage fun exercise such as dancing, “Simon Says” and jumping jacks.
“We’re seeing the difference in BMIs and children are going home and suggesting to parents ways for families to exercise,” says Cheray Burnett, vice president of planning and development at St. John’s Riverside. “Parents are saying, ‘We haven’t heard this before.’ It’s phenomenal.”
Immunizing underserved children is another priority. Since 2001, a nurse outreach worker has visited public schools on a biweekly basis to vaccinate children against hepatitis B. In four years, more than 3,200 vaccines have been administered to uninsured children in Yonkers.
Programs like the Yonkers Childhood Health Initiative are the heart and soul of a health care delivery organization, Foy says, but he stresses that the hospital could not accomplish its mission alone.
Partners, including the school system and the Cochran School of Nursing, give the initiative a truly collaborative spirit. “We looked at [doing] a lot of things in the city, but quickly realized it’d be impossible if we did it on our own,” Foy says. “You have to find like-minded organizations.”
Primary Care Access Network
Health Central, Ocoee, Fla.; Florida Hospital,
Winter Park, Fla.; Orlando (Fla.) Regional Healthcare
Collaboration Cures an ED Crisis
In Orange County, Fla., collaboration proved to be the answer to a pressing health care problem. In 1999, Princeton Hospital, which served patients from underserved and less affluent areas, closed as an acute care facility. At the same time, Orange County was experiencing a growth spurt, especially in tourism-related jobs, which pushed the number of uninsured to 175,000. The fallout was immediate and severe: Other local hospitals experienced a surge in their emergency departments as people turned to their EDs for primary care.
“People were essentially accessing primary care the wrong way,” says Orange County Mayor Richard T. Crotty. “In some cases, people would dial 911 and take an $800 ambulance ride to the ED for a condition that should have been treated by a primary care doctor.”
That tense situation led to the development of the Primary Care Access Network (PCAN), a collaboration of community organizations, the county and three local hospitals—Health Central in Ocoee, Florida Hospital in Winter Park and Orlando Regional Healthcare in Orlando. The three hospital presidents sit on the PCAN board, as does Mayor Crotty.
PCAN was the brainchild of Crotty’s predecessor, then Orange County Chairman Mel Martinez, now a U.S. senator and formerly the U.S. Secretary of Housing and Urban Development under President George W. Bush. Martinez formed a task force charged with creating access to care for people living in the areas that had been served by Princeton Hospital and other health care clinics that closed in the late 1990s.
PCAN’s scope is very broad. Its services include inpatient care; outpatient care, including pediatrics; family planning and maternity care; dental care; short-term recuperative care after hospitalization; behavioral care; and mental-health counseling, among others.
The network’s success is the direct result of the partners’ ability to work together, says Richard Irwin, CEO of Health Central. “We were very active in combining our organizations and efficiencies. When we collaborate, we shut down the competition and we divvy up the work,” he says.
Florida Hospital President Lars Houman agrees, “There has to be a concerted effort by all. We have no problem sharing a view that we can greatly improve community health.”
PCAN has been very successful—more than 50,000 uninsured patients have established contact with a primary care doctor since April 2001 and the shift in care from the ED to primary care clinics has decreased the cost of care from $3,000 to $1,000 per patient, network leaders say.
PCAN’s financial model is also successful: the network is self-sustaining, with partners providing not only in-kind services but financial support as well. “There’s something of a multiples factor to all of this,” Crotty says. “If you create good health for these folks, that’s priceless. There’s a domino effect.”
Dagmara Scalise is a senior editor for Hospitals & Health Networks (H&HN) magazine. This article originally appeared in the July 2006 issue of H&HN.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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