Reinventing hospital care

Anyone who has seen the construction going on at Enloe Medical Center knows that major changes are underway, as the hospital begins work on its $130 million expansion project. Less visible are the similarly big changes going on inside.

It’s safe to say the hospital is reinventing itself. The hope is that ultimately this reinvention will create an environment in which the kind of internal problems the hospital is now having will no longer present themselves.

CEO Debi Yancer and newly hired Chief Operating Officer Mike Wiltermood are dealing with a series of challenges, including being slapped in recent days with a $25,000 fine for a violation found during a state inspection in June. It was the second such inspection this year (the first was in April), and both found several instances of Enloe being out of compliance with Medicare standards.

There also has been considerable attrition at the hospital, with several physicians leaving, as well as a number of allied health professionals such as radiologists and nurses. Anesthesiology, which for so long was so troubled, seems to be mostly back to health, but the orthopedics department is not what it once was. About a year ago local orthopedists stopped taking call, so a revolving “clinic” of out-of-town doctors has taken their place—not an ideal situation.

On the other hand, the hospital is making headway against hospital-acquired infections, a problem that has many local residents worried. Enloe recently announced the results of its participation in a program sponsored by the Blue Shield of California Foundation designed to use innovative technology, called MedMined, that automatically identifies and tracks infection outbreaks early on.

In the first 18 months of the program, the nine participating hospitals collectively reduced respiratory infections by 10 percent, blood infections by 9.5 percent, and urinary infections by 4 percent. Altogether, the program protected more than 600 lives, saved 4,641 hospital days and nearly $2.2 million in costs.

Enloe is so encouraged by the results, said spokeswoman Laura Hennum, that it has decided to continue the program and absorb the cost of MedMined.

Ups and downs, successes and failures—running a hospital is a roller-coaster ride.

In a lunchtime address given Monday (Nov. 5) at the Enloe Conference Center, Wiltermood tried to describe some of the challenges facing Enloe and, indeed, all hospitals in California.

There’s demographics, for one. Baby boomers are becoming seniors, they’re living longer and they’re going to need health care. The Medicare and Medicaid (Medi-Cal) systems are under strain, and reimbursement rates are dropping.

Indeed, everyone is feeling the pressure of rising health-care costs. One-third of bankruptcies are due to medical bills, and millions of people are struggling to pay skyrocketing health-insurance costs. Businesses are seeing their profitability and competitiveness undermined by those same rising costs.

“Enloe would love to see the governor’s [universal-health-care] plan happen,” Wiltermood said. “It would be good for the hospital” because it would pay for charity care Enloe is now providing for free.

Then there’s the lack of medical professionals. Nurses in short supply—ditto X-ray technicians, radiologists and doctors. And California is an expensive place to live. “It’s difficult to recruit from outside the state,” Wiltermood said.

The nature of patients has changed, too, he said, referring to it as the “new consumerism.” Advocacy groups, the Internet and higher levels of education have created patients who increasingly know what they want from their health-care providers and are willing to shop for it.

In such an environment, a stand-alone, nonprofit hospital like Enloe has to be creative to survive. But Enloe has advantages other hospitals don’t have, including its historic connection to the community, as evidenced by the fact that the Enloe Foundation has been able to raise $7.5 million of its $10 million goal for the expansion project.

Chico also has an advantage, Wiltermood said, in attracting doctors and employees because Chico is such an attractive place to live and work. Enloe wants to build on that attractiveness by creating a hospital environment that reflects Chico, one that’s friendly, competent, relationship-oriented and pleasant for employees and patients alike.

Yancer seeks to create a hospital where “transparency” is the norm, where patients receive accurate information, communication flows freely, and the focus is on the healing process, Wiltermood explained.

Achieving transparency must take place at every level, can be uncomfortable at times, is long-term in duration and must emphasize consistency, Wiltermood said. One important step is to create a code of conduct, which Enloe has done. So far nearly 1,500 employees have been trained on the code.

Ultimately, he said, it all goes back to Hippocrates, the father of medicine, who sat under a plane tree, or sycamore, when he taught his students in ancient Athens.

Planetree is the name of a nonprofit consulting group based in Connecticut whose patient-centered model of care Enloe is in the process of adopting.

Hospital officials began looking into Planetree about two years ago, and there has been growing agreement that it is the way to go. Yancer’s arrival has accelerated the momentum, since she already has implemented the model in two hospitals and believes in its value.

It’s now at the point where all of the hospital’s constituencies, including physicians, have signed on, and last week a Planetree consultant offered workshops to some 400 employees.

Planetree has 10 “core components.” There’s insufficient room here to describe them all (go to www.planetree.org for that), but suffice to say they are a mix of eminently commonsensical and what some might consider new-age approaches. The point is that each hospital is free to choose which to emphasize.

The basic principle is that the focus of hospitals is on people caring for people, a concept that can get lost in a hectic operation. Everyone at the hospital is involved, from orderlies to neurosurgeons, as well as friends and families.

Visiting, for example, is unrestricted, even in the ICU and ER, and family members are free to stay overnight and even be present during surgeries.

Hospitals are encouraged to create homey, colorful, non-institutional environments, and there is a big emphasis, too, on providing healthful, nutritious food as well as kitchens where families can prepare food for patients.

Chapels, gardens and meditation rooms are available for reflection and prayer. Touch is healing, so massage is available and encouraged, and such complementary therapies as tai chi, yoga and acupuncture are made available.

Patients have complete access to their charts and can write their own notes on them. They can manage their own medication schedules and are kept fully apprised of information related to their illnesses.

Finally, health care is seen as a community endeavor, and hospitals are encouraged to include the health and wellness of the larger community—through walking clubs, health fairs and kids’ camps, for example—as part of their healing mission.

Enloe has established a leadership team to implement the Planetree model, with Board of Trustees Vice-Chairwoman Judy Sitton leading it. Dr. Marcia Nelson, the hospital’s vice-president for medical affairs, is heading up the physician team. A full-time person soon will be hired to coordinate the process.

Staff is highly enthused about Planetree, the two women say. “I had a nurse come up to me who was so excited about Planetree coming in because that’s why she got into medicine in the first place, to take care of people,” Nelson said. “Planetree connects us back to our roots and helps people not just get better, but heal.”

None of these changes, of course, will make up for a shortage of nurses on the floor, which in the world of hospital patient care is where the rubber meets the linoleum, so to speak. But they could create an environment in which nurses enjoy their jobs more, which may result in more nurses choosing to work at Enloe.

That, in any event, is Debi Yancer’s vision—and her hope.