Catholic Health World - August 1, 2021

Environmental justice 2 Executive changes 7 PERIODICAL RATE PUBLICATION

AUGUST 1, 2021 VOLUME 37, NUMBER 12

Providence mines observations from patients to learn about COVID symptoms, impacts

By JULIE MINDA

In spring 2020, Dr. Ari Robicsek got a call from his sister in Toronto, who said she was having fevers that waxed and waned as well as anxiety attacks that were uncommon for her.

COLOR ME INSPIRED Artist Mike Lroy fills in the details of a monarch on his mural in a 180-foot pedestrian tunnel at SSM Health St. Mary’s Hospital – Madison in Wisconsin. His charge from the hospital’s Mission Action Team was to uplift the spirits of staffers as they come and go from the hospital, reminding them of their mission. Staffers picked up paintbrushes and pitched in. Story PAGE 8.

Require COVID vaccinations or just encourage them?

Systems are split on decision

Cheyenne Boone/St. Louis Post-Dispatch/Polaris

By LISA EISENHAUER

Nurse anesthetist Mary Lou Ponder, left, registered nurse Rachelle Kirschner, center, and nurse anesthetist Lindsey Bright wait in line to receive a COVID-19 vaccine at SSM Health Saint Louis University Hospital in St. Louis in mid-December. At the time, the shots were voluntary. The health system is now requiring them.

At least three Catholic health systems that together have tens of thousands of workers have decided to require COVID-19 vaccines, citing studies that show the shots are safe and effective.

SSM Health announced its policy in late June; Mercy and Trinity Health announced theirs in early July. The policies extend to volunteers, and at least for Mercy and Trinity Health, vendors who work in the systems’ facilities. The systems will allow people to request exemptions because of vaccine-related health issues or religious objections.

Representatives from several other Catholic health systems, including Continued on 3

One system: body and mind

By JULIE MINDA

Continued on 6

COVID-19 tests were in short supply early in the pandemic, and so the 40something mom of four couldn’t get tested.

She asked Robicsek if he thought she was COVID-positive. He told her he didn’t know whether she had the virus — there was no definitive list of symptoms at that time.

Continued on 4

CHRISTUS nurses take stock of the sacred in their work through story sharing

By LISA EISENHAUER

Catholic providers entwine mental health services with medical care Increasingly across the U.S., health care policymakers, payers and providers are recognizing the value of integrating mental health care into the medical health care continuum.

A sampling of ministry systems that are prioritizing this shift says they are determining how best to approach integration by paying attention to national trends and the dynamics of the markets they serve. Much of the focus now is on adding a mental health component to primary care, and on increasing routine screenings to assess mental well-being. Providers acknowledge that patients in every medical care venue have undiagnosed and

My COVID Diary participants receive prompts on their smartphones to chronicle their experiences with the condition. Providence St. Joseph Health is using the entries to advance understanding of how patients experience the disease.

From left, peer recovery support specialist Jerome Reeves, social worker Sarah Krecic and Chief of Behavioral Health Michael Biscaro share perspectives after a peer support session with a client at the Integrated Care Clinic at St. Vincent Charity Medical Center in Cleveland. St. Vincent Charity has prioritized such multidisciplinary work as part of its move toward increasingly integrating mental health care into the care continuum.

At the end of her yearlong residency at CHRISTUS Southeast Texas – St. Elizabeth, Kaitlyn Read joined the other new registered nurses in relating an experience from the previous 12 months that reflected the system’s mission in action.

Read, a labor and delivery nurse, told her fellow residency graduates about how green she felt in her earliest days and how grateful she was for the mentorship of her preceptor, Jaime Laing. “Her patience as she taught me the cervical exams, the neonatal care, the fetal heart monitoring, how to communicate with the doctors and when, was just really extraordinary,” Read Continued on 5

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CATHOLIC HEALTH WORLD August 1, 2021

Former Hollywood actor now fights polluters on Texas’ Gulf Coast Hilton Kelley seeks environmental justice for sick, vulnerable people

Kelley said in west Port Arthur the evidence of health damage is overwhelming among residents, many of whom are Black and poor. A large percentage of children need breathing treatments including nebulizers several times a day. Kelley said he has lost count of the cancer deaths. His best friend died of a cancer earlier this year that Kelley said could have been caused by environmental pollution.

By JULIE MINDA

When Hollywood actor and stuntman Hilton Kelley visited his hometown of Port Arthur, Texas, in 2000 after 20 years away, he was taken aback by how much the Gulf Coast community had deteriorated since his youth. In the city’s socioeconomically depressed west side especially, businesses and services had closed, kids were playing in parks near gang strongholds, and an alarming number of people were ill with chronic disease.

He said that a source of much of the decline — particularly when it came to the health of west side community members — was the close proximity to petrochemical and other heavy industrial companies.

The emissions the facilities spew into the air were causing respiratory problems and skin irritation. Kelley also believes the toxins increase the incidence of certain cancers, heart disease and lung disease, but to his knowledge research has not been conducted to establish causality.

Kelley said he moved back to Port Arthur to defend the community against environmental injustice and to work to promote the health and well-being of its citizens. He’s spent two decades engaging the community in tracking the companies’ emission events, urging regulatory involvement and initiating legal action. At the same time, he and an organization he founded and still runs have been investing in community revitalization.

“I think it’s up to all of us to do what we can to save the children, save the babies, save our elderly. And to help make this world a better place for everyone,” Kelley said during a March 16 webinar sponsored

by CHA and the Catholic Climate Covenant.

Fence-line community Shortly after his move back to Texas’ Gulf Coast, Kelley founded the nonprofit advocacy and community investment organization Community In-Power and Development Association. Seven people — many of them Kelley family members — make up the core paid team at the organization and about 250 people support the nonprofit through volunteerism, he said.

Kelley said west Port Arthur is a “fenceline community,” a designation that environmental justice advocates and some regulators define as areas where low-income populations, mostly people of color, are subject to noise, smells and potentially hazardous emissions emanating from petrochemical and other industrial companies.

Companies in west Port Arthur include Chevron Phillips Chemical, Motiva Enterprises, Oxbow Carbon and Valero petrochemical companies, the German Pellets wood chip storage facility and the Veolia North America waste incineration site.

Petrochemical companies Total, BASF and Indorama Ventures are on Port Arthur’s east end.

The Motiva oil refinery is to the north and diesel pollution wafts from the shipping channel in southern Port Arthur. Kelley said between the companies and the ships, west Port Arthur residents are “boxed in” among numerous potential polluters.

Kelley and other community members keep a close eye on these companies, pho-

Grassroots activism Kelley frequently is tapped as an expert to assist fenceline communities fighting environmental pollution beyond the Gulf Coast. He has testified before Congress about the impact of pollution on vulnerable communities.

Environmental activist Hilton Kelley is seen in front of the TPC Group chemical plant near Port Arthur, Texas. Multiple He’s organized protests, explosions at the plant in November 2019 caused injuries to nearby residents, damaged property and necessitated a collaborated with grassroots mandatory evacuation around a 4-mile radius that included Port Neches, Groves, Nederland and part of Port Arthur. community groups on projects, spoken at churches and tographing evidence of potential violations upgrades that reduce harmful emissions started skill-building and jobs programs for of emission regulations and logging air and ensuring seed funding for social and Port Arthur youth. He’s assembled a “Helpquality readings they provide to substanti- economic redevelopment in west Port ing Hands” volunteer corps to undertake ate complaints to state and federal environ- Arthur and another distressed neighbor- projects that restore the community — they mental regulators. hood through a Port Arthur Communities were busy clearing tree limbs off houses When the flare stacks of petrochemi- Fund. Kelley said he and other local activ- after late 2020 hurricanes, for instance. cal companies belch a dense black smoke, ists also helped prevent the Veolia company Kelley said companies are drawn to Port Kelley said, that indicates they are burning from importing hazardous waste from Mex- Arthur because of the relatively low level off carbon-based fuel. The emissions con- ico for incineration in Port Arthur. of environmental pushback. “It’s the area tain toxic particulates that “rain down” on Kelley said his goal is not to shut down of least resistance.” Given that, he said, west side residences as oily soot, coating companies — the petrochemical industry is empowering the community to speak and homes and yards. Kelley and other commu- the financial lifeblood of Port Arthur — but act in its own interest is essential to addressnity members have documented emission to hold them accountable for adhering to ing environmental injustice. events with trails of black smoke stretching environmental regulations put in place to “We don’t have a voice sitting at the table for miles over the city and emissions lasting protect people’s health. when it comes to city council. We don’t have for days. a voice on the federal level. We don’t have a In 2017, smoldering wood pellets at the Human cost voice on the state level and this is why the German Pellets storage site caused a comIn a May 3, 2019, article, “The Health Community In-Power and Development bustion that sent soot billowing over west Consequences of Weak Regulation: Association was born — to give our city, to Port Arthur for 70 days. There have been Evidence from Excess Emissions in Texas,” give our community a voice.” explosions at petrochemical plants that on the SSRN research platform, analysts have rocked homes and shattered windows. said, “excess emissions in Texas could be Kelley and the Community In-Power responsible for at least $150 million in and Development Association have sued annual health damages from increased Catholic Health World (ISSN 8756some of the companies. He said legal concentrations of primary and secondary” 4068) is published semi­monthly, wins include securing from Motiva plant particulate matter. except monthly in January, April, July

Upcoming Events from The Catholic Health Association Global Health Networking Zoom Call

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Correction

Because of an error, the name of the program CHA is leading to address racial inequities in health care was reported incorrectly in a story in the July 1 edition of Catholic Health World. The name of the program is Confronting Racism by Achieving Health Equity.

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August 1, 2021 CATHOLIC HEALTH WORLD

Mandatory vaccinations?

that the vaccines have so far only been approved for emergency use, Wulff said, but the available data convinced the system’s leaders of their safety and value.

From page 1

CommonSpirit Health, PeaceHealth, Providence St. Joseph Health, Hospital Sisters Health System, SCL Health and Benedictine, said that while they are strongly encouraging staff and volunteers to get vaccinated, they are not requiring immunization as a condition of employment.

In May, the U.S. Equal Employment Opportunity Commission issued guidance that said federal laws “do not prevent an employer from requiring all employees physically entering the workplace to be vaccinated for COVID-19.” The guidance said the policies must provide reasonable accommodations to conform with other federal laws, such as the Americans with Disabilities Act and the Civil Rights Act. The National Academy for State Health Policy reports that the federal guidance has prompted several states to pass or consider laws that ban COVID vaccination mandates.

Setting an example For SSM Health, the decision to mandate vaccinations came down to three factors, said Dr. Shephali Wulff, the system’s director of infectious diseases.

First was an evaluation by the system that showed the rate of seriWulff ous side effects from the vaccines is extremely low while their efficacy is extremely high. Second was timing.

Missouri, where SSM Health has its largest presence, was at or near the top of states in rates of new infections in late June and cold and flu season was nearing, which typically heightens demand for respiratory care.

The third factor was a desire to set an example for the communities SSM Health serves.

“We felt strongly that, as a health care organization, we show the communities that we take care of that we believe in the science of these vaccines,” Wulff said.

Dr. Tammy Lundstrom, Trinity Health’s senior vice president and chief medical officer, said safety Lundstrom was at the forefront in that system’s decision to mandate vaccination.

Safety is a core value for Trinity Health.

“We feel it’s our responsibility to provide safe care and, for the common good in our communities, that we need to be vaccinated to prevent spread and prevent propagation of additional variants that may at some point escape vaccine,” Lundstrom said.

All three systems said their requirements for proof of full vaccination include staffers working remotely.

Ready access Trinity Health set a deadline of Sept. 21 for proof of full vaccination; for SSM Health and Mercy the deadline is Sept. 30. The systems said the dates were picked to allow time for workers to get shots and for those inoculations to be in full effect.

Lundstrom said Trinity Health had given well over a million vaccines in the 22 states where it operates by early July. Access to vaccines is not an issue for staff, she said, noting that in many places, the shots are available on a walk-in basis.

Mike Hubert, vice president for communications at Mercy, said that he had recently been told by an epidemiologist studying the COVID-19 variant spread that because of the transmissibility of the delta variant, reaching herd immunity would require a vaccination rate or post-infection rate of over 90%. Hubert said that means there is almost no chance for someone who hasn’t had a vaccine or the virus to avoid infection in a community where the delta variant becomes prevalent, which has now happened in most parts of the U.S. Some of

Coaxing rather than requiring Among the systems surveyed by Catholic Health World that said they were not requiring vaccines for staff, several declined to elaborate on their policies.

PeaceHealth shared a statement from Chief Physician Executive Dr. Doug Koekkoek. It acknowledged that the Pfizer, Moderna and Johnson & Johnson vaccines all have been shown to be “very safe and effective” and noted that most of the system’s caregivers have been vaccinated.

Dr. Sheetal Sharma, a gastroenterologist with Mercy Koekkoek went on to say: “While based in Washington, Missouri, gets his second COVIDwe are actively monitoring the regula19 shot in January. Mercy is mandating the shots for all tory environment, we have no current of its workers. plans for mandatory COVID-19 vaccination and remain confident in our abilthose infected will be asymptomatic as has ity to provide a safe care environment with been the case with prior variants. the high rates of vaccination that we have In its media release about its vaccination today.” requirement, Mercy noted that most of the SCL Health shared a statement that said hospitalized patients the system was treat- in part: “COVID-19 vaccination remains ing for COVID had not been vaccinated. voluntary at all SCL Health locations at this “What we are seeing aligns with the time. However, as health care providers, we Associated Press analysis of CDC data,” Dr. have a more significant role and responsiJohn Mohart, Mercy’s senior vice president of clinical services, said in the release.

“More than 95% of recent hospitalizations across the U.S. are people who aren’t vaccinated. The data is clear. Vaccination is key to saving lives.”

Ready for pushback Since Trinity Health leaders expected some pushback on the new policy from workers, Lundstrom said the rollout was accompanied by plans for town halls to address workers’ questions and concerns.

“We respect people’s personal decisions and don’t believe that everybody will be positive regarding this decision but with safety as a core value it was something that we felt compelled to do,” she said.

Wulff said SSM Health has ongoing efforts to educate workers about the safety of the vaccines. Those efforts have included town halls, virtual meetings, videos and emails.

SSM Health managers also are making themselves available in person and by email to answer questions about the shots and the vaccination requirement. She pointed out that the system, like others, already requires proof of other vaccinations, such as those for measles, mumps and rubella and for diphtheria.

The system also requires annual flu shots, which have an efficacy rate far below what studies have shown for the three COVID vaccines approved for use in the U.S. SSM Health did take into consideration

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“I think for us it was one of those things where have we used every tool in the tool kit around encouraging vaccines,” said Kathleen Murray, the system’s training and development manager.

“We thought, well, one of the things we haven’t done is a vaccine competition so let’s give this a try and see if it works.”

At the start of the competition, the vaccination Murray rate among communities ranged from 32% to 81%. Murray said that many employees who were vaccinated hadn’t turned in proof. In the first weeks of the competition, the system’s overall vaccine rate jumped by 4% to 62.6% due in part to people bringing in copies of their vaccination cards. “Just even that kind of movement, we are very happy with,” Murray said.

To encourage the competition, Benedictine is emailing a leaderboard each week so communities can see where they stand along with stories from once-hesitant staffers who have changed their minds about getting vaccinated. Communities are posting their vaccination rates and fliers with the stories on bulletin boards.

Data backs decision Wulff said that the data on the safety of the vaccines is overwhelming. She pointed to findings by the Centers for Disease Control and Prevention that of the 331 million doses of COVID vaccines given in the U.S. through early July, the rate of potentially related deaths was miniscule, at about 0.0018%.

The CDC said that — at 2 to 5 incidents per million — the risk of developing anaphylaxis from any of the vaccines is low.

The CDC and the Food and Osacue Brownlee Jr., an operating room technician at Providence Drug Administration reported Alaska Medical Center in Anchorage, gets a COVID-19 vaccinathat as of July 19, with 13 miltion. Providence is encouraging, but not requiring, employees to lion doses of the Johnson & be vaccinated for the virus.

Johnson vaccine administered, 39 individuals developed bility to ensure we are doing everything we thrombosis with thrombocytopenia syncan to slow the spread of COVID-19. This is drome. In mid-July, the FDA also warned why we strongly encourage our associates that the J&J vaccine could lead to a slight risk to get vaccinated to protect themselves, of the rare neurological condition known as their loved ones, our patients, and the com- Guillain-Barre syndrome. munities we serve.”

Wulff said her personal pitch to anyone still hesitant to get a COVID shot is that the Vaccine incentives vaccines are the best hope to end the lingerBenedictine, a senior care provider, is ing crisis. leaving the decision on whether to be vac“The only way for us to get out of this cinated up to employees, but it is offering pandemic safely is for people to get vacincentives. Workers at the system’s 30 long- cinated,” she said. “The longer we wait, the term care communities who show proof more people that remain unvaccinated, the that they are fully vaccinated by Aug. 1 will more time there is for variants to arise. The be entered into a drawing for prizes, includ- delta variant might be our scariest variant ing $2,500 cash. Also, the communities that right now, but the longer we wait the more post the highest vaccination rates or the of these variants there will be until we really biggest jump in vaccination rates during the just don’t have time to wait.” competition will win group meals. Winners will be announced in mid-August. leisenhauer@chausa.org

Ascension St. Vincent in Indianapolis plans $325 million expansion Ascension St. Vincent will invest $325 million to expand its flagship campus in Indianapolis, including relocating Ascension St. Vincent Women’s Hospital there and building a new Brain and Spine Hospital.

The work is set to begin later this year and be completed by the end of 2023.

The Women’s Hospital is now located adjacent to the Ascension St. Vincent campus. The system said in a press release that in its new 268,000-square-foot building, the women’s hospital will have 109 private neonatal intensive care rooms — it now has 97.

A computer generated model of the project at ascension.org/86streetfuture shows the current and future configuration of the campus and the exteriors of the new buildings.

Ascension St. Vincent said the new women’s hospital will allow it to advance its mission to reduce maternal and infant deaths in Indiana. The existing hospital already is home to the state’s largest NICU and one of

only two Level IV perinatal health care centers in Indiana.

The new women’s hospital will be connected by walkways to the adjacent Peyton Manning Children’s Hospital.

The planned Brain and Spine Hospital is part of a collaboration with Goodman Campbell Brain and Spine, a group practice that is not part of Ascension, to create a regional destination for complex neurosurgical care.

“This investment and strategic partnership is in response to significant growth and demand for dedicated neuroscience clinical spaces, including operating rooms, an intensive care unit and an intensive care step-down unit,” said Jonathan Nalli, chief executive of Ascension St. Vincent and ministry market executive for Ascension in Indiana.

The hospital will be integrated with Carmel, Indiana-based Goodman Campbell Brain and Spine research institute and will

house a neurosurgery residency training program. The care will complement the existing Level 1 trauma center at Ascension St. Vincent Hospital as well as the pediatric neurosurgery program at Peyton Manning Children’s Hospital.

In addition to the hospitals, the expansion will include a new parking garage and increased surface parking.

Ascension St. Vincent said 25% of design and construction work for the expansion will be awarded to certified veteran-, women- and minority-owned businesses with at least 50% of every construction dollar going to a company in a community that Ascension St. Vincent serves.

The system operates 24 hospitals and a network of affiliated joint ventures, medical practices and clinics in central and southern Indiana. It employs more than 15,000 associates.

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CATHOLIC HEALTH WORLD August 1, 2021

My COVID Diary From page 1

Robicsek, who is Providence St. Joseph Health chief medical analytics officer, recalls, “I was frustrated — both as an infectious disease specialist and as a big brother — that I couldn’t help her.”

But the conversation got him thinking — what Robicsek if the medical community didn’t have to wait for the traditional, and lengthy, scientific research process to unfold, to better understand the virus?

What if they could somehow ask numerous people who had tested positive for COVID what they were experiencing and then aggregate those responses to develop a COVID profile and symptom timeline?

That nugget of an idea has evolved into “My COVID Diary,” a clinical research project that enlists COVID-positive patients in journaling about their symptoms and experiences so that Providence can mine those entries for discoveries about the disease.

Providence is analyzing this trove of data in order to publish papers on the disease’s progression and symptom permutations and develop approaches to support patients enduring socioeconomic setbacks related to COVID. Sara Vaezy, Providence senior vice president and Vaezy chief of digital and growth strategy, says, “There are a lot of things we’re learning here that can apply when it comes to getting the voice of the patient more closely connected with our work. For example, we’ve learned from COVID that it’s not just about the physical impact of a disease — there also are a lot of social, cultural and sociological impacts” to address.

In the dark Bill Wright is Providence vice president of health innovation research and a member of the team that helped to build out the My COVID Diary project. He recalls that at the start of the pandemic, the medical community was scrambling Wright to figure out what COVID was. “It quickly became clear that there was a lot that was not known. … Usually in medicine we have an idea what we’re seeing, but there of course was no body of knowledge about COVID to inform our clinical response.”

As one way to begin to address this information void, Robicsek brought his idea of gathering information from patients to his Medical Analytics Team as well as to Vaezy, Wright and colleagues in Providence’s digital strategy unit in Renton, Washington. They brainstormed how to solicit such information from patients. They considered but rejected an idea to cull information from the social media feeds of people with COVID. What they landed on was a participatory research approach in which Providence would invite its COVID-positive patients to become citizen scientists by providing narrative and other types of responses to questions delivered via their smartphones.

Traditional research projects usually involve investigators mapping out what they want to know, forming a hypothesis and developing and validating a process to answer the questions being posed. The Providence team wanted something vastly different for this initiative. Wright, who holds a doctorate in sociology, says, “We wanted to hear their input in narrative form, take that data and learn from it. It’s a totally different type of data collection.”

Citizen scientists Since the initiative launched in August 2020, Providence has been contacting

people aged 18 and over who are COVIDpositive, as determined by a test administered at a Providence facility. The introductory text invites patients to contribute to research by sharing their experiences when prompted on their smartphone. People who wish to participate complete a consent form on their smartphone.

Participants initially hear from Providence via text about every other day for the first two weeks, then once a week for the following three months, and then about once a month thereafter. The texts will come for one year.

The team wrote questions, or survey prompts, in conversational English. The questions in the prompts vary based on the patient’s time from diagnosis and severity of symptoms.

Participants may be asked to journal about what they are experiencing including their physical symptoms, or lack of symptoms, and socioeconomic circumstances related to COVID. They may be encouraged to do a head-to-toe check-in. Most of the questions ask for free-form responses with no restrictions on length.

Providence says it is securing the data in a way that protects patients’ privacy and anonymity. Patients are not paid for their participation.

Mining insights Providence is analyzing responses using a technology called natural language processing, which looks for trends and patterns in information.

Robicsek and his team are using the responses in part to develop a symptom timeline. Providence has made initial study findings from the team’s first paper available to study participants on a private website and is inviting their input. Once the research team incorporates their feedback, it will finalize and publish the study.

The researchers hope that Providence clinicians will be able to apply the information to their work with patients who have COVID. The project team is working with Providence’s Center for Outcomes Research and Education in Oregon to analyze patients’ input regarding their socioeconomic challenges related to COVID. That center’s findings will help Providence determine what types of policies to push for in advocacy efforts and the like.

Participatory research As of mid-July, Providence has invited more than 51,000 patients to participate in its survey research on COVID. More than 23,000 people have clicked on that message to learn more. Of those, 6,672 had signed on. Those respondents have completed more than 59,000 journal entries.

“We have been blown away by this response,” says Robicsek. “It’s an embarrassment of riches.”

“We are seeing that when you reach people on their terms and understand what’s important to them, that is the key to engagement,” says Vaezy.

“We are learning things we never would

have, had we not done this project,” says Wright. “It’s a new way of doing science.”

Nonlinear progression Some of the insights the project has turned up include that COVID symptoms can act in a way that is much different than symptoms for most other communicable diseases, says Robicsek. COVID has a very wide variety of symptoms — including fatigue, cough, headaches, sinus issues, anxiety and depression — but symptom onset can happen well after diagnosis. Also, COVID symptoms can come and go over time — just when sufferers think they are recovered, symptoms may return.

Wright notes that the odd trajectory of the disease has rolling ramifications for patients. For instance, their disease progression likely will be different from what human resources departments at job sites are prepared for — workers may need to go on and off sick leave.

Robicsek expects this research project will turn up countless insights — both from a medical and a socioeconomic perspective — that will have practical benefits for patients, their clinicians and others. “My COVID Diary has taught me how interested individuals with this disease are in taking ownership of the work of solving this disease. I am amazed and delighted with the response, and it makes me think: What else can we be doing with participatory research to help patients?” jminda@chausa.org

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August 1, 2021 CATHOLIC HEALTH WORLD

Story sharing From page 1

said. “She gracefully repeated things over and over. I never felt like I needed to hesitate to come to her with any questions.”

Read noted that Laing was always aware of the “delicacy of each situation” at a hospital where labor and delivery patients range in age from 13 to 54, are sometimes substance abusers and can be in the process of trying to turn their lives around after having lost custody of other children. In Laing, she saw “never a judgment, just calm, professional, objective care.”

Read went on to share how, after months of Laing’s guidance at the hospital in Beaumont, she put those essential soft skills into practice while caring for a 16-year-old admitted at 35 weeks gestation with severe preeclampsia. Read explained to the young woman that she would be on strict bed rest with fetal monitoring, a restricted diet, a Foley catheter and an IV drip of magnesium sulfate. The drug is used to prevent seizures in the event of worsening preeclampsia.

Read noticed that her patient had her shoes on under the bedsheets and offered her help to remove them. The teen said she had stepped in a puddle and hadn’t had

time to wash her feet. They were dirty and stinky, so she was just going to leave her shoes on.

Read said she asked herself: What would Jesus do and what would Jaime do?

“The answer was clear,” she recalled. “I went to the bathroom, filled up a tub with soapy water, I came to the bedside, removed her shoes, removed her socks and washed her feet.”

In 2019, he and the others who built the residency curriculum added a segment called Mission in Action to encourage the nurses to watch for those sacred moments when CHRISTUS’ mission to respect everyone who comes to its facilities for care, especially those who are poor and underserved, is evident.

At the start of the residency, Guidroz gives the class a headsup on their final assignment.

“I say that things do get hectic pretty quickly as you’re a new nurse, but you’re going to see and experience some great moments and what I want you to do is to try to file those away and when you come to graduation it’s your opportunity to share those experiences,” he said.

Sacred moments A video of Read telling her story is posted on the website of CHRISTUS Southeast Texas Health System. It is exactly the sort of story that Paul Guidroz, the system’s chief nursing executive, was hoping the new nurses would share at the end of their Kaitlyn Read, a registered nurse at CHRISTUS Southeast Texas – St. residencies.

Elizabeth, is a graduate of its yearlong residency program. As part of that An eye-opening day St. Eliza- program, she shared a Mission in Action story about how her preceptor When the nurses tell their stobeth started embodied the system’s mission to provide compassionate care. ries, Guidroz invites the system’s the residency executive leadership team, cliniprogram in 2017 to tran- 12- to 14-week orientation for new nursing cal directors and nursing administrators sition new college gradu- graduates. Guidroz said the training builds to listen. He also collects the attestations Guidroz ates from student nursing the nurses’ competency as well as their in written form and emails them to the into practice. It replaced what had been a confidence. regional ministry’s entire staff and to top executives of the CHRISTUS system “just so they can hear the great things that these new graduates share with us.”

Read said the sharing of Mission in Action stories was one of her favorite parts of the residency. It reconnected the nurses after they had all been spending most of their time separately getting trained in their specialties.

“I think it was a good eye-opening day for us to see what people are dealing with on other units,” she said, “and it’s a good opportunity for people to speak on what they see in their co-workers and the good work that they are doing.”

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SILVER FRIENDS HealthTrust Huron Loyola University Chicago Lyon Software Mercy Housing U.S. Census Bureau Ziegler

Visit chausa.org/assembly to learn more about these Friends of the Assembly.

Poetic inspiration When it came time for Lynde Freeze to write her Mission in Action story, she found it impossible to zero in on just one memory.

Instead of a story, Freeze, whose specialty is trauma care, wrote a poem that draws upon several powerful moments etched in her memory. The words flowed easily despite the fact that she is not normally poetic, she said, “not even a little bit.”

Her poem references holding the hands of dying patients, trying to save the life of an injured infant, watching an unsuccessful attempt by trauma staff to resuscitate a colleague transported to the ER after a heart attack and staying on duty as the community evacuated before a hurricane.

Her poem includes these lines: “We put on brave faces as we walk through the doors; To tell you your loved one is not coming home.

As our hearts are breaking we are still there; To help you grieve and offer you prayer.”

Personal touch Freeze decided to pursue a bachelor’s in nursing after she had earned a degree in nutrition and found out that she didn’t like the work she was doing. St. Elizabeth, a hospital where she took part in a training program in high school, was her employer of choice and the fast-paced environment drew her to trauma care.

“I always thought if I was going to be a nurse it’s going to be here,” she said. “People here understand. I couldn’t talk more highly of this place.”

Having new nurses recognize that care goes beyond medical needs is what the Mission in Action segment of the residency program all about, Guidroz said.

“It goes above and beyond just a CT scan, an MRI, a robotic surgery, the right medication,” he said. “It’s really trying to give that personal touch, take that personal time and truly set ourselves apart as a Catholic hospital in the way that we care for our patients.” leisenhauer@chausa.org

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CATHOLIC HEALTH WORLD August 1, 2021

Body and mind untreated mental health concerns and they expect to broaden behavioral health service integration beyond primary care; some have already started to do so.

Representatives of PeaceHealth, Providence St. Joseph Health, Sisters of Charity Health System and SSM Health spoke to Catholic Health World about their progress in mental health integration. Each system is taking a slightly different tack.

All are focused on improving access to mental health services and outcomes for patients.

Establishing a foundation Michael Biscaro, chief of behavioral health at St. Vincent Charity Medical Center of Cleveland, says that system had a well-developed psychiatric emergency department, inpatient behavioral health program, addiction treatBiscaro ment and a mental health screening program when it set out to expand and integrate its mental health services last year. In the midst of the COVID-19 pandemic, St. Vincent Charity, which is part of the Sisters of Charity Health System, built out its outpatient mental health services and its intensive mental health treatment services, adding staff as well as a partial hospitalization program and intensive outpatient program.

It opened an integrated care clinic to provide outpatient mental health and primary care. The expansion of behavioral health staff and services is central to its efforts to create a coordinated, connected network of medical and behavioral health care, Biscaro says.

St. Vincent Charity also brought behavioral health and substance dependence screenings into its primary care locations, established one phone number for getting information for all of its mental health services, built awareness of the mental health services among medical practitioners and brought social workers into inpatient medical units and the hospital’s outpatient medical clinic, to help assess patients’ mental health needs.

St. Vincent Charity provides ongoing education and training on mental health care to medical clinicians. It is providing hands-on experience in integrated care to its medical residents as they provide care for patients in its inpatient psychiatry and detoxification units.

Biscaro says communication and part-

Karen Elshout/© CHA

From page 1

Nurse Julie Bryant adjusts her headset as she prepares for a Zoom meeting while working at SSM Health’s Behavioral Health Urgent Care in a St. Louis suburb. The clinic is the first of its kind in Missouri.

nership among all of the care providers is essential to the integration process.

Best practices When Providence Health & Services merged with St. Joseph Health in 2016 to form Providence St. Joseph Health, the combined organization made a commitment to prioritize and improve mental health care services and model ways to integrate mental health into the medical care continuum. It established the Well Being Trust to advance the mental, social and spiritual health of the nation.

Dr. Arpan Waghray, chief medical officer of Providence St. Joseph Health Behavioral Medicine, says the system brought together behavioral health leaders across Providence to identify core metrics that could lead to the greatest impact measured in terms of lives Waghray served and saved. Such services include treatment for depression, suicide care and care for opioid use disorder.

Providence screens all patients for suicidality and most patients are given a screening to assess substance dependence.

The system is creating dashboards that will allow it to compare mental health outcomes in its clinics across the system. Waghray says, “All of this work is being done with a specific focus on equity, aiming to identify care disparities and dive in deeper to find answers.”

He says the system also facilitates the sharing of best practices in mental health care across clinics and across its regions.

For instance, in its guides for integration of behavioral health in emergency departments and primary care, Providence provides practical direction for responding to common behavioral health issues.

The guides are intended to standardize

Providence St. Mary, Kaiser Permanente partner to build Southern California hospital Providence St. Mary Medical Center of Apple Valley, California, is partnering with Kaiser Permanente to build a replacement hospital in San Bernardino County’s Victorville. The partners plan to open the campus in 2026.

They will construct the facility, which will have about 260 beds, on land that Providence St. Mary purchased in 2007 for a replacement hospital. Construction will cost about $750 million. The partners are not disclosing how much capital each will invest.

Providence St. Mary will be the employer and operating manager of the hospital, which will retain its Catholic identity and will continue to adhere to the Ethical and Religious Directives for Catholic Health Care Services. Kaiser Permanente, a health maintenance organization with its own employed panel of direct service providers, said Kaiser Permanente physicians on the staff of the replacement hospital are expected to provide the majority of care to the HMO’s members. Community physicians includ-

ing doctors from the Providence St. Mary medical staff not employed by Kaiser may be involved in treatment of the insurer’s patients based on their specific medical care needs and physician coverage in the hospital on any particular day.

The Victorville site will replace the 213bed facility in Apple Valley, about 10 miles away. The Apple Valley hospital opened in 1956. Leaders of the partner organizations say that hospital is outmoded and it would be too costly to bring the facility into compliance with the state’s seismic requirements that take effect in 2030.

The organizations say the partnership will enable them to combine resources to improve care delivery in the High Desert region of San Bernardino County. The construction site is centrally located in an area of rapid population growth.

Providence St. Mary is creating an ad hoc committee of hospital and community leaders to assess local health and community leads in order to determine potential uses for the Apple Valley campus.

approaches to behavioral health conditions across the Providence system.

Providence assembled a network of psychiatrists and social workers to provide telebehavioral health to 36 rural sites, including critical access hospitals that previously had no behavioral health services. Now, those medical facilities can offer a behavioral health specialist consult within 30 minutes, seven days a week. Through this work, last year Providence served an additional 10,000 patients who previously would not have had access to behavioral health care, says Waghray.

Urgent care Michelle Schafer, regional vice president of behavioral health for St. Louis-based SSM Health, says the system’s primary care locations conduct behavioral health screenings to detect and make referrals for behavioral health issues before they escalate to crisis. The system’s primary care Schafer locations have behavioral health practitioners available to further assess and treat patients, either on-site or through virtual visits.

Nearly a year ago, SSM Health opened its Behavioral Health Urgent Care in suburban St. Louis to provide immediate assessment and triage of urgent mental health needs. It is the only such specialized urgent care in the state of Missouri. Patients who would benefit from ongoing care are referred to SSM Health behavioral health providers or linked to community mental health centers and other local not-for-profit organizations that provide services to those with chronic mental illness.

In October, SSM Health responded to increasing behavioral health care needs among youth by opening the urgent care facility to patients younger than age 18. That group now makes up 20% of its volume.

“Our goal is to offer ongoing care and a path to wellness by working with a host of community partners who can meet individuals where they are,” Schafer says.

“When we can identify and stabilize people who need mental health services — especially those among our most vulnerable populations — we can raise the overall health of the community.”

No wrong door In PeaceHealth’s Oregon network, Carla Gerber is clinical manager of behavioral

health services and Joan Tompkins is manager of behavioral health operations. Gerber says that system has been using grants to integrate mental health services across the continuum of care for 18 Gerber years and has made significant progress. PeaceHealth Oregon screens for depression among primary care patients and for suicidality among all emergency department patients. It screens priTompkins mary care patients aged 12 to 24 for psychosis, in the hopes of intervening with those at risk, with preventive care.

Tompkins adds PeaceHealth has brought mental health services into primary care settings and primary care services into mental health settings — in a process it calls reverse integration. This way, patients can access mental health and medical services wherever they are most comfortable receiving care.

PeaceHealth also is bringing mental health and primary care services to the vulnerable through a multidisciplinary mobile team that goes to local shelters to deliver care.

“We need to figure out how to change the system to meet the patients’ needs rather than trying to force people to change to meet the needs of our system,” she says. “We want to provide the services right where people are more likely to be.”

Awareness building Megan Bush, director of intake and access for the behavioral health practice area of St. Vincent Charity, says the pandemic’s broad toll on the nation’s mental health put mental health conversations in the mainstream and is helping to reduce Bush stigma and to build awareness of the importance of improving access to mental health services. She says such changing attitudes could help to speed the progress toward fuller integration of mental health care into the care continuum.

Her colleague Biscaro says, “A silver lining of the pandemic is that it highlighted how challenged the health care system is …

“And we’re seeing momentum for change now.”

AHA report sets out ways mental health can be woven into other care venues “B

ehavioral Health Integration: Treating the whole person,” a 2019 report from the American Hospital Association’s Center for Health Innovation, defines integrated care as the systematic coordination of physical and behavioral health care in acute care, primary care, emergency care, post-acute care, health homes and/or community-based services. The authors say that effective integration goes beyond mere collaboration and coordination between medical and mental health practi– tioners: “The aim of integrated care is one system of care for physical and behavioral health delivered by the care team with different clinical specialties along the entire care continuum.”

The report recommends a variety of approaches for achieving that level of integration, and it says that systems can take progressive steps along the integration path.

Ministry providers are using these and other blueprints to incorporate mental health services into the care continuum. The report recommends systems: Conduct behavioral health screenings with patients of medical facilities to identify people at risk.

Use electronic health record systems to prompt medical practitioners to assess patients for behavioral health conditions.

Educate primary care physicians on behavioral health and related screenings and assessments.

Enlist outpatient clinicians in documenting patients’ behavioral health symptoms and needs in the electronic health record.

Embed behavioral health clinicians in medical settings.

Open units or facilities equipped to treat chronic physical conditions and psychiatric needs.

Open behavioral health urgent care centers that are integrated into the medical urgent care system.

Collaborate with community-based mental health service providers.

Partner with community providers on data collection and analysis having to do with community mental health.

Invest in tele-mental health to extend mental health providers’ reach.

August 1, 2021 CATHOLIC HEALTH WORLD

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Britton to transition to executive chair of Mercy board in 2022 Lynn Britton will transition from president and chief executive of Mercy health system to executive chair of the Mercy Board of Directors at a yet to be determined date in 2022.

This fall, the Mercy board will name Britton’s successor. The new president and chief executive will be an internal candidate, chosen from among the members of Mercy’s senior leadership team, according to information from Mercy. The new candidate will assume the chief executive role when Britton becomes executive chair. The transition is part of a succession plan the Mercy board has been developing for several years.

Britton has worked in the Chesterfield, Missouri-based Mercy system for nearly three decades. At the beginning of his Mercy career, he was director of materials management at Mercy Health Center in Oklahoma City and then executive director of materials management for St. John’s Mercy Health Care in St. Louis. From 2000 to 2004 he was vice president for Mercy’s supply chain operating division. From 2004 to 2009, he was a Mercy senior vice president. He has been the top executive at the system since 2009.

In 2017, CHA recognized Britton with its Sister Concilia Moran Award, which the association gives annually to recognize exceptional creativity, leadership and breakthrough thinking that advances the ministry. Two years after Britton assumed

health outcomes.

At the time of CHA’s recognition of Britton, Sr. Mary Roch Rocklage, RSM, said, in that article: “Lynn is a visionary who sees the delivery of health care as a permeating, rather than institutional, presence in our communities. He is a real collaborator who has molded a strong leadership team while setting direction. And he has created an environment where people who serve here feel alive, nourished and motivated to use

their talents for the good of all.” Sr. Rocklage is health ministry liaison of Mercy Health Ministry, Mercy’s public juridic person. She was president and chief executive of Mercy from 1986 to 1999.

Britton also has received the Missouri Hospital Association’s Distinguished Service Award and Modern Healthcare’s CEO IT Achievement Award. Becker’s Hospital Review has named him one of its 100 Great Healthcare Leaders to Know.

KEEPING UP Lynn Britton

the helm of what was then the Sisters of Mercy Health System, that system reorganized as Mercy, and Britton oversaw the unifying of its facilities under that brand.

Mercy today includes 40-plus acute care and specialty hospitals, more than 900 physician practices and outpatient facilities and 40,000-plus employees located across four states.

Under Britton’s leadership Mercy created its Virtual Care Center to be the hub of the system’s telemedicine programs.

Also, by integrating medical management with telehealth services, online and telephone support under Britton’s leadership, Mercy said in a Catholic Health World article on Britton’s honor that the system had reduced readmission rates and improved

California. He was operations leader for Providence Mission Hospital’s two campuses in Southern California.

Robin Godwin to president of Ascension Sacred Heart Bay in Panama City, Florida, from vice president of nursing at Ascension Sacred Heart Gulf in Port St. Joe, Florida.

Wooten

Godwin

PRESIDENTS AND CEOS Providence St. Joseph Health of Renton, Washington, has made these changes: Walter L. Cathey to regional chief executive of the Covenant Health System of Lubbock, Texas, from chief executive of the Lubbock market for Covenant Health. Cathey will succeed Richard Parks, who is retiring. Terry Wooten to chief executive of Providence Queen of the Valley Medical Center in Napa,

Community Benefit 101 Virtual in 2021!

Community Benefit 101: The Nuts and Bolts of Planning and Reporting Community Benefit VIRTUAL

OCTOBER 12, 13 & 14, 2021 Each day from 2 – 5 p.m. ET

Who should attend: CHA’s CB 101: The Nuts and Bolts of Planning and Reporting Community Benefit, a virtual conference, will provide new community benefit professionals and others who want to learn about community benefit with the foundational knowledge and tools needed to run effective community benefit programs.

Attendees will receive a copy of CHA’s A Guide for Planning and Reporting Community Benefit!

What you will learn: Taught by community benefit leaders, the program will cover what counts as community benefit; how to plan, evaluate and report on community benefit programs; accounting principles and a public policy update.

While it is designed for new community benefit professionals, the new virtual format now makes this meeting accessible to a wider audience, including:

v Staff in mission, finance/tax, population health, strategic planning, diversity and inclusion, communications, government relations, and compliance who want to learn about the important relationship of their work and community benefit/ community health.

v Veteran community benefit staff who want

a refresher course to update them on current practices, inspire future activities and connect with others in nonprofit health care doing this work.

WE HOPE YOU’LL JOIN US ONLINE! LEARN MORE AT CHAUSA.ORG/COMMUNITYBENEFIT101

NEW CHA OFFICE CHA’s Washington, DC, office has a new location: The Catholic Health Association of the United States 1625 Eye Street NW Suite 550 Washington, DC 20006

Chief of Staff CHA seeks a chief of staff. This position will support the president and chief executive officer and coordinate with the senior leadership team to maximize the effective management of the office of the president/CEO. The chief of staff will balance a mix of strategic and programmatic responsibilities and will work closely with leadership to coordinate, align, and build cohesion across the organization and to advance the organization’s priorities. The chief of staff will act as a key communicator linking the leadership with the broader organization. The chief of staff also leads specific initiatives at the direction of the president/CEO. The chief of staff will be based in CHA’s Washington, D.C., office.

Some travel is required.

The Catholic health ministry is the largest group of nonprofit health care providers in the nation and is composed of more than 600 hospitals and 1,600 long-term care and other health facilities.

To ensure vital sponsorship and a vibrant future for the Catholic health ministry, CHA advocates with Congress, the administration, federal agencies, and influential policy organizations to ensure that the nation’s health systems provide quality and affordable care across the continuum of health care delivery.

CHA is seeking candidates with a minimum of five years’ progressive management experience and relevant and progressively responsible professional experience in communications and/or public relations in a health-related field.

Five years’ experience as chief of staff or special assistant to the president preferred. This position requires a minimum of a master’s degree in business, health, related field, or equivalent experience. To view a more detailed posting for this position, visit the careers page on chausa.org.

Interested parties should direct resumes to:.

Cara Brouder, Senior Director, Human Resources Catholic Health Association 4455 Woodson Road St. Louis, MO 63134 Phone: 314-427-2500 For consideration, please email your resume to HR@chausa.org

We are an Equal Employment Opportunity employer.

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CATHOLIC HEALTH WORLD August 1, 2021

The colorful mural designed by local artist Mike Lroy and painted by him and staffers at SSM Health St. Mary’s Hospital – Madison in Wisconsin fills both sides of a subterranean pedestrian tunnel that connects an employee parking lot to the hospital.

Mural in SSM Health hospital tunnel brightens passage for workers

By LISA EISENHAUER

the work has sections with inspiring words or phrases he project that SSM Health such as “compassion,” St. Mary’s Hospital – Madi“healing mission” and son in Wisconsin hired art“patient experience.” The ist Mike Lroy for wasn’t a simple Mission Action Team asked one. that those words be part of The hospital, through its Mis- Right choice the artwork to reflect the sion Action Team, commissioned In addition to enthuhospital’s core values and him to turn a 180-foot pedestrian siasm, Lroy checked all to remind staff of the hospitunnel into a work of art that the other boxes that the tal’s mission to care for and would lift the spirits of staff, mir- team was looking to fill respect life. ror the hospital’s mission and when it began its search Bolstering employees’ values, pay tribute to its heritage for a mural artist. He is well-being has been a focus and salute the workers who would local. He is one of the artfor the hospital as well as pass by it every day. In addition, ists who during racial for the system leadership the hospital asked that the proj- justice protests last year and of particular concern ect be an interactive one with staff brought color and vitality given the extra burden that invited to join. to boarded-up business workers took on during the “We wanted to create this windows downtown. And COVID-19 pandemic, Leet space that would be inviting and his designs are simple but says. uplifting but also mirror our com- distinct.

“It’s going to take a long mitment to the When the Mission time to recover and it’s kind local community,” Action Team found out of like grief, you just sort of says Susan Leet, that Lroy had students recover in stages,” she says.

St. Mary’s chap- work on a mural at an ele- The mural’s oak tree is inspired by the trees and garden on the grounds of SSM Health St. Mary’s “I think this idea of keeping lain supervisor. mentary school in nearby Hospital – Madison. staff well-being foremost She leads the Mis- Sun Prairie, Wisconsin, in our mind is really, really sion Action Team, Leet says the members some part in this installation.” them got more ambitious, adding important.”

Leet a volunteer group knew they had their artist. in their own elements, such as a During the worst months of the that finds ways to reinforce the For Lroy, getting input and Staffers get creative bumblebee. crisis, the Mission Action Team hospital’s healing mission and assistance from those who will His mural at St. Mary’s includes “There were things that, even festooned the tunnel with posters values. be seeing his art is a given. “A big a huge oak tree, leaf-laden vines on the last day, were added to the and cards sent by the community Leet says the high expectations theme that I stick with is unity,” he and dozens of monarchs, a nod to piece that are perfect additions,” to thank the hospital’s staff. The for the public art piece might have says. “I like to incorporate as many the trees and butterfly garden on Lroy says. “I think it turned out mural is a permanent replacebeen intimidating to some art- people as possible in the process the hospital grounds. St. Mary’s beyond all of our expectations.” ment offering similar inspiration, ists, but they weren’t to Lroy. She so there’s always a sense of fam- staffers were invited to work Leet says it was fascinating Leet says. recalls his eyes lighting up as soon ily and community. No matter beside him to fill in the colors of to watch the mural progress. In as he saw the tunnel, which runs what skill level, everyone can have the leaves and butterflies. Some of addition to the natural elements, ‘The world works here’ The artwork was funded through the Mission Action Team’s budget and a grant from the hospital’s foundation. Lroy began the artwork in late April and completed it in mid-June.

Though the tunnel mural is complete, Leet says Lroy’s work at St. Mary’s might not be finished.

A hospital committee focused on diversity, equity and inclusion has a proposal to turn a wall just inside the hospital adjacent to the tunnel into another huge canvas. It would depict a map of the world and include the slogan “The world works here.” The hospital would invite workers to somehow mark where they are from, however they define the concept.

If that installation falls into place, Leet expects others to follow. “I’m imagining that that will continue, different groups will come forward to sponsor something and we’ll just keep adding until we run out of space,” she SSM Health St. Mary’s Hospital – Madison staffers join artist Mike Lroy to color in butterflies. Lroy says having people pitch in on his projects helps create a sense of unity says.

T

around the art.

under a road and connects an employee parking lot with the hospital. “He was like, ‘Wow, this is a dream come true for an artist like me.’”

leisenhauer@chausa.org