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FOCUS TOPICS

WOMEN’S HEALTH • NEUROLOGY • CNO ROUNDTABLE • HEALTH EDUCATION

May 2009 2018 >> $5 December ON ROUNDS New Guy in Town ‘Rewarded’ With Heavy Challenge When Dr. Sanjeev Kumar came to Memphis he found a heavy problem awaiting him – literally. The doctor who had a fellowship in gynecology/ Sanjeev Kumar oncology was seeing many obese patients, fortunately for everyone.

Profile on page 3.

Patients, Caregivers Welcome Increased Alzheimer’s Funding New research funding and the laws to support patients and caregivers enhance the efforts of the Alzheimer’s Association to meet its goal Rachel Conant to prevent or effectively treat the disease by 2025.

Story on page 5.

A Welcome Report, Openings, Awards Are All in the News

HealthcareLeaders

Five Memphis CNOs Share Nursing Insights

Compassionate Roundtable Discusses Job’s Most Vital Issues By BETH SIMKANIN

Editor’s note: Five chief nursing officers from five Memphis hospitals were invited by the Memphis Medical News to participate in a roundtable discussion during a luncheon at the new G Alston Restaurant in Cordova. The publication has gleaned the group’s critical and compassionate assessment of key nursing issues and transposed the remarks into this feature-length article in honor of the profession many call “the heart of healthcare.” The month of May celebrates nursing and includes National Nurses Week. As the top nursing management professional in any healthcare organization, the chief nursing officer (CNO) must wear many hats and work with other healthcare leaders to establish policies that benefit the entire nursing staff and improve clinical care. Now more than ever, CNOs play a vital role and offer unique clinical insights in day(CONTINUED ON PAGE 8)

Sustainable Solutions Considered For Possible Physician Shortage By CINDY SANDERS

Memphis hospitals win awards, a new health care building opens its doors, and a report that Tennessee is making strides in the opioid battle are some of the stories in Grand Rounds.

News on pages 10-14.

ONLINE: MEMPHIS MEDICAL NEWS.COM

The five chief nursing officers who composed the Memphis Medical News’ nursing roundtable are Wanda Rook-Peperone, Saint Francis Bartlett; Kathleen Seerup, Le Bonheur; Kathy Barnes, Methodist Germantown; Lisa Cox Schafer, Regional One; Susan Ferguson, Baptist Memorial Health Care Corporation.

Karen Fisher

Complex problems rarely have simple solutions. Such is the case with the looming physician shortage facing the United States. New research published last month by the Association of American Medical Colleges (AAMC) shows increasing shortages looming for both primary and specialty care. The new data outlined in the 2018 update of “The Complexities of Physician Supply and Demand: Pro-

jections from 2016-2030” provides a forecast based on a number of supply and demand scenarios, including an aging population on the demand side and heavier reliance on other physician extenders on the supply side. Recognizing it is impossible to accurately predict exactly how market forces will play out over the coming years, each supply scenario is paired with a demand scenario to create a projected shortfall range. Part of AAMC’s commitment to annually updat(CONTINUED ON PAGE 4)

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PhysicianSpotlight

Taking On Tough Task of Obesity Surgery Sanjeev Kumar Found Right Place to Put Laparoscopy, Robotics into Practice By LAWRENCE BUSER

When Dr. Sanjeev Kumar came to Memphis in 2013 after a fellowship in gynecology/oncology at the Mayo Clinic, he found a patient population of heavyweights. With Dr. Kumar’s expertise in robotic and laparoscopic surgery, the Baptist Medical Group Gynecology Surgical Center soon became ground zero for obese patients, a group that poses a greater degree of difficulty in surgical procedures. “When I came to Memphis, we started getting these challenging patients and it was like ‘Let the new guy in town have these difficult cases that nobody else wants,’” Dr. Kumar recalled. “Gradually we started developing methods and I started training my staff and operating team, and we started getting excellent results in very obese patients. “Now in my practice, 80 to 90 percent of my patient population is obese. A lot of other physicians do not feel comfortable dealing with very obese patients, but with the surgery we’re offering we have seen the dramatic impact this makes in the patients’ lives.” Obesity is measured by Body Mass Index (BMI), which is the weight in kilograms divided by the square of height in meters. Generally, 18 to 25 BMI is normal, somewhat above that is overweight and higher than 30 BMI is obese. According to the Centers for Disease Control, two-thirds of Americans are overweight, while more than a third are obese. Under the blunt headline “The Fattest Cities in America,” an online publication called WalletHub regularly has Memphis and surrounding metro areas in its top five. Last year the top three were Jackson, Mississippi; Memphis and Little Rock. “We figured if we’re going to do obesity-related work, we are in the right geographic region,” Dr. Kumar said. “There is a lot of need for robotic pelvic surgery in obese women. With open surgery in obese patients, you have to cut through more skin, more flesh and therefore you have a much higher rate of infection. “The greater fat tissue has a lower blood supply, so the healing is slower, you may have long-term wound-care problems and things like that. Robotic surgery eliminates all of those problems to a great extent, and that’s a big advantage.” While some 60 percent of the practice is hysterectomy surgery, Dr. Kumar and his team also perform robotic procedures for ovarian tumors and cysts, cervix and uterine cancer, and other pelvic-region surgeries. Gynecologic cancer, pelvic pain, heavy bleeding and fibroids are other common problems that can be cured with MEMPHISMEDICALNEWS

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robotic pelvic surgery, the doctor added. He said laparoscopic or robotic surgeries are better methods than open surgery for treating such problems. Like laparoscopic or keyhole surgery, robotic surgery begins with a few dime-sized incisions in the abdomen, but mechanical arms with surgical instruments become extensions of the surgeon. The first robotic surgery system was approved by the FDA in 2000. Looking through a magnified, 3D high-definition camera, the surgeon can literally do some heavy lifting with the sur-

gical arms by raising the abdominal wall of an obese patient to better observe the operating field. The robotic arms also offer 360-degree movement of the surgical instruments, which are manipulated by the surgeon as he cuts, cauterizes, sews and dissects tissue. “It’s a combination of dexterity and computer knowledge, plus a fair bit of eyehand coordination is required, and obviously lots of practice,” said Dr. Kumar, who estimates he has performed some 4,000 robotic pelvic surgeries. “Robotic surgery actually started with the U.S. military, which was looking at the concept of having a surgeon on a ship or city being able to take care of soldiers on a battlefield without physically being there. That’s how a lot of robotic surgery concepts evolved, but that’s not the routine clinical practice.” He said patients routinely worry that the doctor will not be in the operating room at all and that the surgery will be performed by a robot with a mind of its own. “Some people will come in and say ‘I want to have the surgery, but I want to see the robot first,’” Dr. Kumar said. “They want to make sure a human is controlling the robot. I tell them that I’ll be right there controlling the robot myself. It’s not the robot that’s doing the surgery.

“My fascination with surgery began when I was a kid growing up on a farm in India driving tractors. I wanted to do something manual. I thought I would be good at something where I could work with my hands. “I went to medical school in India and got my training in robotic and laparoscopic surgery at the Mayo Clinic. That instilled the belief in me that I could really do these challenging cases, especially since there’s such a need for them.” He points out that in its annual honor roll rankings, U.S. News and World Report last year ranked the Mayo the No. 1 hospital in six specialties, including gynecology. Dr. Kumar has an older brother who is a farmer and a sister who is an attorney, both living in India. He and his wife, who uses only one name, is Dr. Sumedha, an internist at Baptist Hospital. They have a daughter, 7, and a son, 3. Whether the children follow their parents into the medical field will be up to them. “This is such a fascinating and satisfying field that I would love to encourage them to enter the medical profession and explore being surgeons as career options,” Dr. Kumar said. “But honestly, I want to encourage them to develop whatever they want to do. That’s when you do the best work, when it comes from within your heart and your mind.”

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Searching for Sustainable Solutions, continued from page 1 ing physician workforce projections, the latest report increased the forecasted physician shortfall to between 42,600 and 121,300 by 2030. This is up from last year’s report, which projected a physician shortfall of 40,800 to 104,900 by that same year. The shifting demographics of the U.S. population continue to be a key driver of demand. “Our data shows by 2030, the U.S. population aged 65 and older will grow by 50 percent,” said AAMC’s Chief Public Policy Officer Karen Fisher. She added the supply side of the equation is impacted by several factors including the hours physicians are willing to work, the number of providers nearing retirement, and the

quantity of young physicians completing training to fill in those gaps.

Schools Step Up

Allopathic and osteopathic medical schools have both seen increases in enrollment over the last several years as academic centers have pledged to help alleviate projected workforce shortages. According to AAMC data, there were 21,338 new enrollees in allopathic medical schools for the 2017-2018 academic year, a 1.5 percent increase over the previous year. Total enrollment for 2017-18 was 89,904 students compared to 81,936 in the 2012-13 year, a nearly 10 percent increase over the last five years and closer

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to a 20 percent increase over enrollment a decade ago. The American Association of Colleges of Osteopathic Medicine (AACOM) saw first-year matriculation jump with a nearly 7 percent increase in fall 2017 enrollment over the prior year. Preliminary figures from AACOM placed 2017 total enrollment at 28,981, an all-time high for the 34 accredited colleges of osteopathic medicine in the United States.

GME Bottleneck

While growing medical school enrollment is a positive step, Fisher and colleagues point out increasing the number of students won’t translate into more physicians and surgeons if there aren’t adequate training slots for graduates. “The Medicare program has been a key financer of graduate medical education,” said Fisher, who added Medicare historically funded GME on a proportionate share of a resident’s training. For example, if a resident trained at a facility where Medicare made up 30 percent of the patient population, then the federal program would pay 30 percent of the physician’s GME cost. However, continued Fisher, “In 1997, Medicare placed a cap on that support … so for over 20 years, Medicare’s support has been capped at the number of residents in 1996.” For every resident above the hospital’s cap, she said, the facility has had to absorb that extra cost. “It’s like they are taking a cut every year by virtue of that cap,” Fisher added. For the most part, she continued, there have been slots available for graduates because hospitals have borne the additional training costs. In some cases, states have stepped in to help with additional funding, as well. However, Fisher said sustaining the current setup is an ongoing concern. “When clinical revenues get tight, we’re very concerned about the ability of teaching hospitals to continue to train residents above the cap,” she said. “It’s important that we continue to receive

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stable, predictable financing to offset the significant costs associated with training new physicians.” AAMC, along with AACOM, strongly supports legislation that would moderate the chilling effect the current cap has on physician training. “We’re asking for 3,000 residency positions each year for five years for a total of 15,000 residency positions,” noted Fisher. The bipartisan Resident Physician Shortage Reduction Act of 2017 (HR 2267, S 1301) was introduced last May but didn’t make it out of committee. However, Fisher said there might be another chance to gain some traction if Congress takes up infrastructure this year. “I think the physician workforce is an important infrastructure need for the health of our country,” she said.

Other Options

AAMC officials have repeatedly stressed the need for a multi-pronged approach to addressing the physician shortage. While enrollment and GME are huge components to the solution, there are other factors being addressed, as well. “Overall, our modeling certainly looks at the role and growth of nurse practitioners, physician assistants and telehealth,” she said of utilizing teams and technology to extend the delivery system. AAMC also supports non-GME incentives and programs, including Conrad 30, the National Health Service Corps, loan forgiveness programs and Title VII/VIII, which are used to recruit a diverse workforce and encourage physicians to practice in shortage specialties and underserved communities. Fisher said foreign-born physicians are another potential part of the solution and noted those trained outside of America must undergo a rigorous assessment before being allowed to practice in the United States. “They are an important source of physicians in this country,” she said. “Many of them tend to practice in rural and underserved areas,” she added of filling gaps in care. Additionally, AAMC has been a champion of increasing the physician workforce in a manner that embraces diversity and cultural competency to mirror the nation’s changing demographics and to work towards eliminating health disparities. Fisher noted the AAMC also has released several statements calling for healthcare workers with DACA status to be able to continue their education, training and research. Similarly, the organization has expressed concerns over executive actions on immigration and travel impacting researchers and clinicians. In an issue brief from March 17, 2018, the organization noted, “Because disease knows no geographic boundaries, it is essential that we continue to foster, rather than impede, scientific cooperation with clinicians and researchers of all nationalities as we strive to keep our country safe from all threats.” Fisher concluded, “We certainly support national security, but we believe this is an issue of national health security.” MEMPHISMEDICALNEWS

.COM


Leaders in Women’s Healthcare Introducing the Next Decade of McDonald + Murrmann

Alzheimer’s Association Sees Increase in Federal Support

Patients, Researchers, Caregivers All Score Wins By CINDY SANDERS

In March, President Donald Trump signed a massive $1.3 trillion omnibus spending bill into law to fund the federal government. Part of the spending package included a $414 million increase for Alzheimer’s and dementia research funding at the National Institutes of Health (NIH). Rachel Conant, senior director of Federal Affairs at the Alzheimer’s Association, leads the organization’s efforts to elevate Alzheimer’s disease as a priority for the federal government. She also serves as senior political director of the Alzheimer’s Impact Rachel Conant Movement (AIM), which is the national association’s advocacy arm. “The Alzheimer’s epidemic has a profound impact on families,” she said, adding her own family had been touched by the disease. “The Alzheimer’s epidemic has a profound implication for state and federal budgets,” Conant continued. “Nearly one in every five Medicare dollars is spent on Alzheimer’s or related dementias.”

Alzheimer’s Stats

Just days before the spending bill was signed, the Alzheimer’s Association released a new report outlining the toll of the disease. “The 2018 Alzheimer’s Disease Facts and Figures” found increases memphismedicalnews

.com

in prevalence, deaths and cost of care. An estimated 5.7 million Americans are living with Alzheimer’s dementia in 2018, nearly two-thirds of Americans with Alzheimer’s are women, 10 percent of those 65 and older have the disease, and the incidence rates are even higher in older African-Americans and Hispanics. Alzheimer’s cases are expected to spike alongside the nation’s aging population with an estimated 14 million living with the disease by 2050. Currently, someone in the United States develops Alzheimer’s every 65 seconds. The Alzheimer’s Association predicts by mid-century, someone will develop the disease every 33 seconds. Although deaths from other major diseases have decreased, recorded deaths from Alzheimer’s disease increased 123 percent between 2000 and 2015. The sixth leading cause of death, the new report stated Alzheimer’s is the only one among the top 10 causes of death that cannot be prevented, cured, or significantly slowed. In addition to the human toll, the financial cost is staggering. The 2018 Alzheimer’s Association report cited a $277 billion cost to the nation for Alzheimer’s and other dementias with a projection that those costs could rise to as much as $1.1 trillion by 2050. The current cost represents nearly a $20 billion increase over last year.

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Conant noted that in 2011, landmark legislation laying the groundwork to create a national Alzheimer’s strategy was (CONTINUED ON PAGE 6)

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Alzheimer’s Association Sees Increase in Federal Support, continued from page 5 signed into law. The National Alzheimer’s Project Act (NAPA) created an advisory council to make recommendations to the Secretary of Health and Human Services in three key areas: research, clinical care, and long-term services and support. “That was the first time we really saw the federal government put an emphasis on Alzheimer’s funding and research,” Conant said. She added with this latest $414 million NIH increase earmarked for Alzheimer’s and dementia research, federal funding has now risen to $1.8 billion. A great deal of work is being done to better understand the underlying mechanism of Alzheimer’s and related dementias, and there are a number of promising drug trials underway that hope to stop or slow down disease progression. “We’re really excited about the focus not only on treatment but on prevention,” said Conant. “We just announced the 2018 launch of the Pointer Study, which is a two-year

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clinical trial to look at multifactorial and lifestyle interventions to prevent cognitive decline and dementia,” she continued. The intervention methods will include exercise, nutritional counseling, cognitive and social stimulation, and improved self-management of health conditions. For more information, go online to alz.org/us-pointer.

Kevin & Avonte’s Law

Also included in the omnibus bill was funding for Kevin and Avonte’s Law, bipartisan legislation to protect seniors with dementia and children with developmental disabilities who are prone to wander. Conant said AIM has spent several years working on the bill, which reauthorizes the Missing Americans Alert Program through fiscal year 2022 and expands the program to include those with developmental disabilities. Introduced by Reps. Chris Smith (R-NJ) and Maxine Waters (D-Calif.) in the House and Sens. Chuck Grassley (R-Iowa) and Amy Klobuchar (D-Minn.) in the Senate, the new law provides up to $2 million in grants each year to state and local agencies for programs to prevent wandering or locate missing individuals.

RAISE-ing Caregivers Up

Yet another legislative win for the Alzheimer’s Association and AIM came earlier this year with passage of the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act.

“From the Alzheimer’s perspective, we know there are more than 15 million caregivers providing unpaid care to individuals,” said Conant. The 2018 Facts and Figures report estimated these individuals provide 18.4 billion hours of care valued at over $232 billion. Research has shown caregivers of people with dementia report higher levels of stress, depression and worse health outcomes than those caring for individuals without dementia. In 2017, these additional stressors led to Alzheimer’s caregivers incurring an extra $10.9 billion in health costs. Sens. Susan Collins (R-Maine) and Tammy Baldwin (D-Wis.) and Reps. Gregg Harper (R-Miss.) and Kathy Castor (D-Fla.) introduced the bipartisan legislation. The new law directs the Department of Health and Human Services to develop a national strategy to provide education and training, longterm services and supports, and financial stability and security for caregivers. Conant said her organization worked closely with AARP to push for passage of RAISE, which was modeled off of NAPA. “It will require a plan to be updated annually,” Conant said. “It’s also going to create a National Family Caregiving Council to provide recommendations to the (HHS) Secretary.”

Providers & Care Planning

Conant said the Health Outcomes, Planning and Education (HOPE) for

Alzheimer’s Act that passed in November 2016 provides a funding mechanism for providers to be reimbursed for assessing and discussing a diagnosis of Alzheimer’s disease and available treatment and support options to improve or maintain quality of life. “Beginning in 2017 for the first time, people living with Alzheimer’s now have access to care planning with a medical professional, and it’s paid for by Medicare,” she said, adding the Alzheimer’s Association has a downloadable care planning toolkit for providers. For more information, go online to alz.org/careplanning.

Moving Forward

“The goal is to prevent or effectively treat Alzheimer’s by 2025,” said Conant. “We’re excited about our progress, but we know we have a long way to go.”

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The Department of Surgery in the College of Medicine at the University of Tennessee Health Science Center has launched the UTHSC Global Surgery Institute to coordinate, support, and expand surgical mission work done around the world by faculty and students. Nia Zalamea, MD, an assistant professor of surgery, and Martin Fleming, MD, chief of surgical oncology and associate professor of surgery, are the organizers of the institute, which will anchor surgical mission work across the department, assist residents and students interested in mission work, and apply lessons learned around the globe to local delivery of clinical care. “It ties all of our separate projects into one home base,� Dr. Zalamea said during the announcement late last month. Dr. Zalamea has done medical mission work annually in the Philippines since 1999 with her father, a nurse anesthetist, and mother, a nurse, both of whom were born in that country and came to Memphis in the 1970s. The family founded the Memphis Mission of Mercy, a 501 c (3) non-profit, and has made yearly missions to the Philippines since. Dr. Fleming has participated in medical missions to the Philippines with Dr. Zalamea’s organiza-

PHOTO BY MATT DUCKLO/MEMPHIS MISSION OF MERCY

UTHSC Department of Surgery Launches Global Institute

Dr. Nia Zalamea with patients and their family members during a medical mission in the Philippines.

tion and to Tanzania to teach and perform clinical work. “Within the Department of Surgery, we’ve organized ourselves because there are all of these projects happening all over the world,� Dr. Zalamea said.

A survey done during the organizational phase showed approximately 20 surgical faculty members at UTHSC were providing 58 weeks of mission work each year around the globe on their own time. (CONTINUED ON PAGE 8)

Dr. Nia Zalamea

  

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Five Memphis CNOs Share Nursing Insights, continued from page 1 Kathy Barnes Title, hospital – Chief nursing officer, Methodist Le Bonheur Germantown Hospital. Birthplace – Cleveland, Ohio. Nursing School – BSN and Masters of Science in Nursing from St. Louis University. Nursing experience –SSM Health St. Mary’s Hospital, St. Louis, where she served as administrative director of nursing operations. Other leadership positions include the interim chief nursing officer and director, critical care services. Credentials – Adjunct professor in the Webster University graduate program. Board certified nurse executive by the American Nurses Credentialing Center and a Magnet appraiser for the American Nurses Credentialing Center Magnet Recognition Program.

to-day staff operations. They spearhead hospital management issues such as quality of care, patient safety, patient and family experience, nursing standards of care, leadership development, succession planning, personnel management and budgetary responsibility. Recently, in honor of National Nurses Week, May 6-12, a group of five CNOs took a critical and compassionate look at key issues facing chief nursing officers in the Mid-South today at a roundtable discussion conducted by Pamela Harris, publisher of the Memphis Medical News. They discussed the nationally high turnover rate of CNOs, the challenge of retaining a reliable staff, current nurse recognition practices and how their personal experiences have assisted them professionally over the years. Participants in the discussion were: - Kathy Barnes, CNO, Methodist Le Bonheur Germantown Hospital - Susan Ferguson, vice president and system chief nurse executive, Baptist Memorial Health Care Corporation -  Wanda Rook-Peperone, CNO, Saint Francis Hospital, Bartlett -  Lisa Schafer,  COO and CNO, Regional One Health - Kathleen Seerup, vice president of patient care and CNO, Le Bonheur Children’s Hospital

High Turnover

All five CNOs agreed that turnover among CNOs is high nationally. Three of the five CNOs present at the roundtable discussion have been in their roles for less than one year and the other two for less than five years. This reflects a national trend. According to the American College of Healthcare Executives, CNOs tend to stay in their roles for two and a half to 8

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MAY 2018

five years. Saint Francis’ Rook-Peperone agreed this national trend is reflected in the Mid-South. “The average CNO stays in the position from three to eight years in the Memphis area,” she said. “It’s a tremendous responsibility as it takes time to get settled into the role and build a team which builds longevity.” All five experts said CNO turnover is related to many changing factors, including hospital CEO turnover, the retirement of longtime CNOs, job availability and location.

Regional One’s Schafer said the hospital CNO and CEO work together to build a long-term strategic plan for the healthcare system. As a result, she said the greatest turnover happens in hospital executive management when the CEO leaves an organization. “The CNO and CEO have a synchronized partnership,” she said. “A new CEO wants to choose the CNO on his or her team.” Although statistics could not be found for the rate of national CNO turnover, hospital CEO turnover remains at 18 percent for the third consecutive year, according to a report by the American College of Healthcare Executives. Continuous consolidation of healthcare organizations over the past decade and retiring leaders from the baby boomer era influence these turnover rates. Seerup, of Le Bonheur Children’s Hospital, agreed that many longtime CNOs at hospitals are retiring, especially in pediatric hospitals. “There wasn’t CNO turnover in pediatrics nationally until recently,” she said. “Within the last 18 months there have been a large number of CNOs retiring. Generally, CNOs at pediatric hospitals were in the position for a long time. The CNO worked for the same hospital and grew within the organization. “Now, you must step outside the organization to advance. You must move to a larger-scope children’s hospital because the same CNO or CEO have been in the same position for a long time.” Barnes, the CNO with Methodist Le Bonheur Germantown, said job availability is a factor for many potential CNO candidates. There aren’t enough leadership positions available at every hospital. “There are fewer opportunities for advancement the higher up in leadership

Wanda RookPeperone Title, hospital – Chief Nursing Officer, Saint Francis Hospital-Bartlett. Birthplace – Hernando, Mississippi. Nursing School – Methodist School of Nursing (Saint Francis University, Joliet, Ill. (BSN); University of Memphis Loewenberg School of Nursing (MSN). Nursing Experience – Critical Care Nursing and Emergency Department Nursing as staff RN with progressive leadership roles in each area (Charge RN, Assistant Nurse Manager, Nurse Manager (Critical Care and Emergency Department), Director Emergency Department, Associate Chief Nursing Officer. Credentials – RN, MSN.

Susan Ferguson Title, hospital -- Vice President/System Chief Nurse Executive, Baptist Memorial Health Care Corporation. Birthplace – Memphis, Tennessee Nursing School – Memphis State University (now University of Memphis Loewenberg College of Nursing).

Nursing experience – A 30-year Baptist employee, she has served in a variety of roles throughout the system, most recently as system nursing director for clinical value analysis/specialty care/ patient safety. Prior to serving as the system nursing director, Ferguson was BMH-Collierville’s CNO; system director of nursing; director of nursing administration; director of oncology services; and CNO for Baptist in the metro-Memphis area, West Tennessee and East Arkansas. She began her career in B

Credentials – Received the Tennessee Organ for Excellence in Nursing Leadership in 2009, 2015, was president from 2011-2013. Served College of Nursing. She is a registered nurse

you go, so you must be prepared to move to a new health system,” she said. “There is only one CNO and CEO position for each hospital.” Ferguson, the vice president and system chief nurse executive with Baptist, said location plays a role in CNO turnover. She has seen CNO turnover lower in rural areas in the Mid-South. “In a rural community,” she said, “the CNO has usually been a nurse for a long time at that facility. There is more competition in a big city. Succession planning is so important and must be in place for when the CNO leaves.” All CNOs agreed that it’s important for hospitals to consider nurses for executive management positions as they have a unique patient and staff perspective. Ferguson said nurses hold four executive management positions at Baptist. Additionally, Barnes said it’s important when researching for a CNO position to look at an organization as a partner. “Look at the culture, values and practice style to make sure there is an affinity there,” she said. “It’s not a case of just finding a job, but a partner.”

Retaining Good Staff

All five CNOs said it’s a challenge to retain nurses with the many employment options nurses have today, but the answer to retaining good employees is to compassionately listen to them and let them know they make a difference within the organization. “In my experience, the main objective is for nurses to know they have a voice within the organization,” Baptist’s Ferguson said. “It’s important that those in nursing leadership are visible and listen to the staff. Nurses want to be heard and know that they are part of making decisions.” Acknowledging nurses in small ways shows nurses they are valued. memphismedicalnews

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Baptist’s emergency department.

nization of Nurse Executives (TONE) award , erved on the TONE Board from 2008d on Dean’s Advisory Board for Loewenberg e and has a master of science.

“Small things mean a lot to a nurse,” Le Bonheur’s Seerup said. “Sending a birthday card or anniversary card to their home is a small gesture that can go a long way in letting someone know he or she matters.” Barnes, of Methodist Le Bonheur Germantown, said the CNO must always be visible and interact with employees. “You have to be accessible,” she said. “It’s important to leave your desk and walk the hallways. Nurses are vital to an organization. They provide exceptional care at the most vulnerable of times. Be available to them during troubling times. Look at pictures of their children and encourage them to have fun and advance in their career.” Schafer, at Regional One, said CNOs must recognize nurses more within organizations. Both formal and informal recognition programs can go a long way in retaining nurses. “Engaging your staff and recognizing them for their hard work is key,” she said. “Our profession is trained to look at problems and make decisions. People want to know they are valued, and it’s our job to focus on them and recognize them.” 

Nurse Recognition Matters

All five CNOs agreed that offering nurses financial incentives to stay with their current healthcare systems assists in retention, but recognition programs give nurses a sense of belonging to a family. Ferguson said small incentives such as offering continuing education and certifications and honoring nurses with the DAISY Award for Extraordinary Nurses, which is a national merit-based award recognition program, showcase that an organization invests in its nurses. Rook-Peperone said that it’s important to research how nurses want to be memphismedicalnews

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recognized. “For example,” she said, “bedside nurses don’t like a lot of pomp and circumstance.” Schafer said the element of surprise is a fun way to recognize a nurse for his or her work. She recalled a time at another healthcare organization when the CNO dressed in a trench coat and glasses and played the theme to Mission Impossible as part of a nursing recognition program. The CNO gave pens to the nurses that said “Mission Accomplished.” Several CNOs said they receive recognition themselves when their staff achieves a milestone. “I’m more metric driven,” Schafer said. “My biggest thrill is when my team achieves a goal we’ve been working toward. It means more to me when something is accomplished by the people I lead.” Saint Francis’ Rook-Peperone said that when former patients recognize nurses for a job well done, it makes more of an impression, as there is a personal connection between the patient and the nurse. “It’s nice to see the staff react to reading letters from their family or to hear from patients who received an exceptional level of care,” she said. “When you’ve touched your team in that way, you feel like you’ve arrived.” Barnes said a visit from a former patient makes a personal and passionate impact. “It’s seeing a patient walk who couldn’t before that makes such a difference in a nurse’s career,” she said. “As a nurse, we only touch them at one point during their sickness or recovery.” For all CNOs, it’s meaningful for them when a former co-worker contacts them about how they made a difference in his or her career. “I received an email one time from

Kathleen Seerup Title, hospital – Vice President of Patient Care and Chief Nursing Officer, Le Bonheur Children’s Hospital. Birthplace – Evergreen Park, Illinois. Nursing school – University of St. Francis, Joliet IL – MSHA; Lewis University, Romeoville, IL - BSN; South Suburban College, South Holland, IL – ASN Nursing Experience – Senior Director, Critical Care Services, Director, Pediatric Intensive Care Unit, Administrative and Operations Manager PICU, Children’s Memorial Hospital, Chicago, IL Interim Director PI Registered Nurse, Pediatrics CU, Clinical Manager PIC Team Leader PICU, Family Care Coordinator, PICU, Manager, Clinical Operations, Pediatrics. Credentials –BSN, MSHA, RN, NE-BC.     

a nurse who I helped get employment,” Seerup said. “She said, ‘Thank you for helping me be the best nurse I can be.’ I couldn’t get a better compliment than that. It makes a difference when you’ve had an impact in someone’s life like that. You never forget it. I get goose bumps just thinking about it.”

Inspiring Experiences  

All five CNOs had very different personal experiences that made a difference in their career choices, but they all agreed they were attracted to nursing because

Lisa Cox Schafer Title, hospital -- Chief Operating Officer and Chief Nursing Officer, Regional One Health. Birthplace – Honolulu, Hawaii. Nursing School – University of North Carolina, Bachelor of Science in Nursing; and Medical University of South Carolina, Master of Science in Nursing Administration. Nursing experience – Nursing management and leadership roles for more than 30 years in academic medical centers and community hospitals including Scripps Health System in San Diego, California; Roper Saint Francis Healthcare and the Medical University of South Carolina. Credentials – RN, MSN, NEA-BC (Nurse Executive Advanced-Board Certified).

they wanted to help people and make them better. “I’ve always wanted to be a nurse,” Rook-Peperone said. “When I was little I would use toilet paper to wrap my dolls, which I imagined were hurt and needed care. It’s a privilege to be one.” For Seerup, choosing to become a nurse was more personal. She wanted to provide the exceptional care that her brother didn’t receive when he was terminally ill. “I wanted to be an accountant at first,” she said. “I had two personal experiences which convinced me that nursing was the profession for me. My father had a heart attack at 40 and survived and my brother had metastatic brain cancer. I saw how my brother wasn’t provided compassionate care, and I wanted to change that. I wanted to provide compassionate care to people who are sick and become a leader.”    Ferguson’s experience as a nurse was valuable for her current role, but it wasn’t until she was in hospital management that she felt she learned the skills necessary to be a hospital executive. “It’s through the different leadership positions I’ve held over the years where I have learned the most, especially those outside my skill set,” she said. “I learned how rural hospitals work and how different they function in a small community. For instance, they don’t have transportation services or a 24-hour pharmacy. As I look back, one leadership role helped prepare me for the next.” Schafer said it’s important to have a broad perspective to be a CNO. “Many CNOs come from a background in critical care and emergency care,” she said. “It’s a fast-paced environment, and you have to make quick decisions. This type of background helps prepare nurses for future leadership roles. You have to focus and stay on course.” MAY 2018

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UTHSC Department of Surgery at Launches Global Institute, continued from page 7 “That’s breathtaking,” Dr. Zalamea said. The physicians, many of whom, like Dr. Zalamea, are affiliated with Methodist Le Bonheur Health Care, donate their surgical skills to help people in China, Vietnam, Honduras, Nicaragua, India, and the Philippines, among many destinations. The survey also showed 60 percent of incoming residents were interested in doing international work as part of their training, and 65 to 70 percent of medical students had already been involved in international work prior to residency, she

said. “That’s a pretty moving statistic,” she said. “Not only do they want it, but they’ve already engaged in it,” Dr. Zalamea said. The UTHSC Global Surgery Institute is a partner of the American College of Surgeons, which links it with similar organizations nationally and globally and expands overseas opportunities and support. A Global Surgery Support Fund has been established through the UT Foundation to offer scholarships for travel expenses to medical students, surgery

residents, and surgery fellows interested in doing mission work. To help fund the scholarships, the Global Surgery Institute is holding its first fundraiser May 11 from 6-10 p.m. at The Brass Door, 152 Madison Avenue, and the Madison Avenue Park across the street. Admission is $10, or $5 with a student ID, and includes refreshments and entertainment. Ethicon Endosurgery, a manufacturer of surgical devices, is helping sponsor the event. The UTHSC Global Surgery Institute includes an active student advisory and support group. One of those students,

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Janyn Quiz, 24, in her first year of medical school, grew up in the Philippines and moved to the United States two years ago with her family. “I’m really grateful for my country, and I want to give back to them as much as I can,” she said.

GrandRounds Rhodes Student Publishes Research Evaluating Recurrent Pregnancy Loss

Filoteia Popescu, a Rhodes College junior with majors in biochemistry and molecular biology and neuroscience, has published an article proposing a new procedure for evaluating women who experience recurrent pregnancy loss. She published the article with Rhodes biology professor Carolyn Jaslow and Filoteia Popescu William Kutteh of Fertility Associates of Memphis in a March issue of Human Reproduction, an international peer-reviewed scientific journal. The title of the article is “Recurrent Pregnancy Loss Evaluation Combined With 24-Chromosome Microarray of Miscarriage Tissue Provides a Probable or Definite Cause of Pregnancy Loss In Over 90 Percent of Patients.”  Research participants included 100 women with recurrent pregnancy loss (RPL) seen in a private fertility clinic. All 100 women had two or more pregnancy losses, a complete evaluation for RPL as defined by the American Society for Reproductive Medicine, and miscarriage tissue evaluated by 24-chromosome microarray analysis after their second or subsequent miscarriage. Popescu’s research role included interpretation, analysis, and synthesis of data, the original draft of the article, manuscript review and editing, and critical discussion. “That an undergraduate is the first author on this type of publication is extraordinary,” Jaslow said. “I think it is likely that this article will change the testing procedures for women seeking help for RPL in fertility clinics throughout the world.” RPL is frustrating for physicians to treat, according to Popescu, and the recommended workup could only identify probable causes for RPL about half the time. The procedure that she and her collaborators have proposed involves adding the 24-chromosome microarray analysis as the first step to the standard RPL testing procedure. “This step should not only allow physicians to identify a definite or probable cause for pregnancy loss in more than 90% of patients, but it will also provide substantial savings in overall healthcare costs,” says Popescu.“It also is emotionally devastating for couples to experience recurrent pregnancy loss, and for some patients, knowing the cause for a loss may provide comfort. The proposed procedure would provide patients with those answers in a cost-efficient and timeefficient manner. I am thrilled that this article has the potential to contribute to new therapies and policies that can help future couples.” memphismedicalnews

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GrandRounds

CONSOLIDATED MEDICAL PRACTICES OF MEMPHIS

salutes the Engbretson Center for Women and the work of its three providers.

Dr. Malone graduated from the University of Tennessee College of Medicine at Memphis in 2007. She completed her OBGYN residency training at the University of Tennessee College of Medicine in 2011. She is a member of IHI Committee Baptist Women’s Hospital here in Memphis.

The Clinical Trials Network of Tennessee will support clinical research efforts across the UT System. From left to right, Phil Cestaro, Karen Johnson, Chancellor Steve Schwab, Steven Goodman, Robert Davis, Bill Mason, and Ari VanderWalde.

UTHSC Launches Clinical Trials Network of Tennessee The University of Tennessee Health Science Center (UTHSC) has launched the Clinical Trials Network of Tennessee (CTN2). Operating as a separate 501(c) (3) subsidiary of the University of Tennessee Research Foundation (UTRF), CTN2 was created to enable UTHSC clinical research faculty to design, solicit, and conduct robust statewide clinical trials with the overarching goal of providing new therapeutics and medical devices aimed at improving the health of all Tennesseans. The Clinical Trials Network of Tennessee was the vision of Steven R. Goodman, PhD, vice chancellor for Research at UTHSC. “CTN2 will provide robust statewide clinical trials that will improve medical treatments, while providing UTHSC credit for the clinical trial contracts being performed by its faculty who are located at participating hospitals throughout the state,” Goodman said. CTN2 will allow UTHSC faculty to respond to opportunities for clinical trials at the speed of industry. The UT Board of Trustees committed $3 million in 2017 to support the first three years of CTN2 operations, and on March 23, 2018 the board agreed to release the first-year funds to UTRF, which will then fund CTN2. “Based on UTRF’s experiences supporting other projects across UT, we’ve established CTN2 as a nonprofit UTRF subsidiary and set up the bylaws to ensure that its governing board represents all of the stakeholders,” said Richard Magid, PhD, vice president of UTRF at UTHSC. Dr. Magid has also been elected to serve as the UTRF board representative for CTN2.

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Memphis Medical News! FOCUS TOPICS FOR OUR JUNE ISSUE:

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To be notified when the next issue is posted online, please send your email address to pamela@memphismedicalnews.com.

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Dr. Engbretson has practiced obstetrics and gynecology in the Memphis area since 2007. She is in private practice but also focuses on underserved neighborhoods in the Memphis area via the Morning Center, a mobile maternity unity providing charitable prenatal care. Kathleen Behnke, FNP, has joined the Engbretson Center for Women as our nurse practitioner and will offer personalized care including a wide range of in-office patient care including well woman exams, and pre and post-natal care. Behnke received her Master’s of Science in Nursing from the University of Tennessee Health Science Center in 2008.

Shannon Riedley-Malone, MD, Laura Engbretson, MD, Kathleen Behnke, FNP

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GrandRounds

OIG Offers Online Access to Compliance Resources By Denise Burke A virtual reality room at the new UTHSC Center for Healthcare Improvement and Patient Simulation (CHIPS). The room will allow students to practice simulated endoscopies, ultrasound procedures, and robotic surgeries.

UTHSC to Open $39.7 Million Center for Healthcare Improvement May 11 The University of Tennessee Health Science Center (UTHSC) plans to open its $39.7 million Center for Healthcare Improvement and Patient Simulation (CHIPS) on May 11. The 45,000-square-foot, facility at 26 South Dunlap is dedicated to education, research, and professional development of enhanced clinical skills using standardized patients (actors trained to portray patients), high-fidelity patient simulators (manikins costing from $15,000 to $220,000), and virtual reality technology. According to university officials the building, which has been under construction since 2015, is the only one of its kind in Tennessee and one of only a handful in the country built for and totally dedicated to simulation training. The center will allow students from the six colleges at UTHSC – Dentistry, Graduate Health Sciences, Health Professions, Nursing, Medicine, and Pharmacy – to train together in simulation settings to develop their skills in delivering team-based health care, which is the proven model for the highest-quality care today. Each floor of the three-story building is dedicated to a different aspect of simulation training. The first floor includes bed-skill stations that will allow students to focus on preclinical skills and assessments. A virtual reality room allows students to practice simulated endoscopies, ultrasound procedures, and robotic surgeries. There is also a simulated home environment, where students can practice delivering in-home patient care.

Methodist North Hospital President Receives Honor Florence Jones, president of Methodist North Hospital, is one of four outstanding Murray State alumni to receive the 2018 Distinguished Alumni Award presented last month during an awards dinner on the campus. Jones, a 1975 nursFlorence Jones ing alumna, has served more than 25 years in the healthcare industry and has broken through countless barriers of gender and race throughout her years of experience. Jones has established a reputation for collaborative and inspirational leadership during her career. She also served the U.S. as a first lieutenant in the Army Nurse Corps for the United States Army Reserve from 1977 to1980. Established in 1962, the Distinguished Alumni Award is presented annually to alumni who have made meaningful contributions to their professions on a local, state and national level. It is the highest honor an alumnus can receive from the Murray State Alumni Association. Prior to becoming president of Methodist North, Jones served as chief nursing officer and interim president for Methodist North and chief nursing officer for Methodist South.

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UTHSC Assistant Professor Receives Research Grant

Brian M. Peters, PhD, assistant professor in the Department of Clinical Pharmacy and Translational Science in the College of Pharmacy at the University of Tennessee Health Science Center (UTHSC) has been awarded $418,000 to continue Brian Peters his research repurposing compounds to fight against inflammation that results from vulvovaginal candidiasis (VVC) -- commonly referred to as a yeast infection. VVC is among the most prevalent fungal infections found in humans -- 75 percent of women suffer from this condition at least once in their lifetime. “Current therapies for VVC are focused mostly on antifungal administration, which for the most part, is fairly effective,” Peters said. “But there is a subset of women (five to eight percent) who have recurrent disease and have to maintain that antifungal therapy throughout their lives, or they will continue getting symptoms over and over again.” Peters and his team are attempting to develop a potential way to treat VVC by repurposing FDA-approved compounds found in common therapies used to treat other diseases, such as type-2 diabetes. This new potential inflammation therapy would be used as a co-therapeutic to common antifungal therapies.

A new website offering “one-stop shopping” to healthcare organizations and providers seeking assistance with compliance efforts has been launched by the Office of the Inspector General (OIG) in conjunction with the Department of Health and Human Services (HHS). The site is well organized and can provide managers and compliance officers with compliance guidance and training materials to support their compliance programs. In its role, the OIG serves as an independent and objective oversight authority over programs operated by HHS, including the Centers for Medicare and Medicaid Services (CMS), public health agencies (such as the Centers for Disease Control and Prevention) and human resources agencies (such as the Administration for Children and Families). The website (available at oig.hhs.gov/compliance) offers a wide range of public resources, including: • Compliance toolkits • Provider compliance resources and training • Advisory opinions • Voluntary compliance and exclusions resources • Provider compliance resource and training • Special fraud alerts, other guidance, and safe harbors • Resources for health care boards • Resources for physicians • Accountable Care Organizations Under the Toolkits section, for instance, there are resources for measuring compliance program effectiveness, dealing with adverse events and a guide for building The Author: and operating healthcare boards. The site will continue adding new resources over time, including a soon-to-be-released guide on identifying patients at risk for opioid misuse. The site offers a roadmap tool for new physicians, along with some opportunities for continuing education. There’s also a special section specifically for accountable care organizations. The site is also a good resource for staying on top of recent OIG guidance, including advisory opinions, fraud alerts Denise D. Burke is an and safe harbor regulations. attorney with Waller in The OIG Work Plan, which had Memphis. previously only been updated once or twice a year, is now updated monthly online. The OIG Work Plan serves as “advance notice” to providers of specific risk areas that will receive attention from the OIG, outlining upcoming OIG audits and evaluations that are underway or plan during the current fiscal year and beyond.

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GrandRounds Article Reports Tennessee Making Strides in Opioid Prescribing

Saint Francis Bartlett Wins Patient Safety Award

An article published by the IQVIA Institute for Human Data Science (“Medicine Use and Spending in the U.S.,” April 2018) reports that Tennesseans filled 6,709,154 opioid prescriptions at retail pharmacies in 2017, close to a 9 percent decrease from the previous year and a 21.3 percent drop from 2013. The report states that Tennessee outperformed most of its contiguous states and is on par with the national average for year-over-year improvements and fiveyear trends. The Tennessee Medical Association, the state’s largest professional organization for doctors, says the data is “validation of the medical community’s ongoing efforts to self-regulate prescribing and reduce initial opioid dosage and supply.” National trends show 22.2 percent fewer opioid prescriptions were filled in 2017 than h in 2013, with every state in the nation showing some reduction in the past year. In 2017, a total of 196 million opioid prescriptions were filled in the U.S., representing an 8.9 percent decrease from the prior year – the sharpest single-year decrease reported by IQVIA. Prescription opioid volumes in the U.S. peaked in 2011 at 240 billion milligrams of morphine milligram equivalents and have declined by 29% to 171 billion MMEs.

Is the missing

Saint Francis Hospital-Bartlett has been honored with an “A” Hospital Safety Grade by The Leapfrog Group, an organization that hopes to improve health care quality and safety for consumers. Saint Francis Hospital-Bartlett officials said their facility was the only one in Shelby County to receive the “A” Hospital Safety Grade. It is the ninth consecutive “A” grade for Saint Francis HospitalBartlett. The Leapfrog Hospital Safety Grade assigns letter grades to hospitals nationwide based on their performance in preventing medical errors and infections. The grade is designed to provide consumers with information they might want when making decisions about a hospital stay. The Leapfrog Hospital Safety Grade is calculated by using 27 measures of publicly available hospital safety data. Approximately 2,500 hospitals have been assigned scores, with less than a third receiving an “A” grade.

MidSouth Imaging Welcomes J. Bret Winblad J. Bret Winblad, MD, has joined MidSouth Imaging in the practice of Interventional and Diagnostic Radiology at Baptist Memorial Hospitals – Memphis, Collierville, DeSoto, Tipton, Women’s, Huntingdon, and NEA.

Baptist Adds New Feature to Its Telehealth Services Baptist Memorial Health Care has added a telehealth component to its metro and regional facilities that is designed for intensive care unit patients. Through new eICU monitoring technology, known as TeleGuardian, speciallytrained ICU registered nurses in Baptist’s TeleHealth Center based in Memphis will work directly with the hospital’s intensive care and critical care teams, serving as real-time support and collaborating with teams on the floor. A camera and monitor mounted on the wall in one of the hospital’s intensive care units, nurses in Memphis can view a patient in real time, said Stacy Hammett,

director of Baptist’s eICU, who Hammett helped direct the launch of eICU in 12 of Baptist’s 21 hospitals. Patients benefit in several key ways, including: • Higher overall survival rates • 24/7 remote patient monitoring by experienced critical care nurses who can answer questions or discuss patient care • Education and mentoring for newer ICU nurses • Changes in patients’ conditions are quickly identified in real time and addressed immediately to help avoid complications during recovery. • Shorter lengths of stay in the unit for some patients • Fewer days on a ventilator • Lower rate of preventable complications, such as pneumonia and sepsis

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Dr. Winblad is a graduate of University of Kansas School of Medicine and completed Diagnostic Radiology Residency training at University of Kansas School of Medicine, Wichita. Dr. J. Bret Winblad Winblad completed an Interventional Radiology Fellowship at Alleghany Health Network, Pittsburgh. Dr. Winblad is Board Certified in both Diagnostic Radiology and Interventional Radiology. His special interests are in Peripheral Vascular Disease and Liver Cancer.

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