Big Challenges Made Small

We all know that there are continuing challenges that we in heath care face each day. But with all the global challenges including wars and the recent Haiti earthquake and its unbelievable devastation, it is important to remember each day that it is the miracle moments--however small--that you make happen that continue to truly make the difference in people’s lives. It is usually the aggregations of small acts of kindness and compassion that change the world.

Money, ships, troops, organizations, and supplies continue to arrive in Haiti, but the positive outcomes we all hope for will only occur when one person interacts with another to assess and treat an injury, hand out food, distribute medicine, give words of encouragement, extend a warm hand, offer a big hug, or quietly say a prayer. We must always remind ourselves that the “bigger picture” of sustained improvement would never get painted without the individual strokes of many “artists” like you!

What reminded me to write this message was the brief story below that I came across recently while I was on the road. But more importantly, it reminded me once again just how critical our 30,000 CHRISTUS Associates, 9,000 physicians, 1,800 volunteers and 250 governance participants are in assuring that, as the CHRISTUS Family, we are continuously carrying out our Mission, living our Values and mapping out the Journey to Excellence so as to reach our Vision. Each day, each task, each miracle moment is what it is all about. Stop today and thank your teams for all they do to “answer the myriad of letters sent to God.”

Our 14-year-old dog, Abbey, died last month. The day after she died, my 4-year-old daughter Meredith was crying and talking about how much she missed Abbey. She asked if we could write a letter to God so that when Abbey got to heaven, God would recognize her. I told her that I thought we could so she dictated these words:

Dear God,

Will you please take care of my dog? She died yesterday and is with you in heaven. I miss her very much. I am happy that you let me have her as my dog even though she got sick. I hope you will play

with her. She likes to play with balls and to swim. I am sending a picture of her so when you see her You will know that she is my dog. I really miss her.

Love,
Meredith

We put the letter in an envelope with a picture of Abbey and Meredith and addressed it to God/Heaven. We put our return address on it. Then Meredith pasted several stamps on the front of the envelope because she said it would take lots of stamps to get the letter all the way to heaven. That afternoon she dropped it into the letter box at the post office. A few days later, she asked if God had gotten the letter yet. I told her that I thought He had.
Yesterday, there was a package wrapped in gold paper on our front porch addressed, ‘To Meredith’ in an unfamiliar handwriting. Meredith opened it. Inside was a book by Mr. Rogers called, ‘When a Pet Dies.’ Taped to the inside front cover was the letter we had written to God in its opened envelope. On the opposite page was the picture of Abbey and Meredith and this note:

Dear Meredith,

Abbey arrived safely in heaven. Having the picture was a big help. I recognized Abbey right away. Abbey isn’t sick anymore. Her spirit is here with me just like it stays in your heart. Abbey loved being your dog. Since we don’t need our bodies in heaven, I don’t have any pockets to keep your picture in, so I am sending it back to you in this little book for you to keep and have something to remember Abbey by. Thank you for the beautiful letter and thank your mother for helping you write it and sending it to me. What a wonderful mother you have. I picked her especially for you. I send my blessings every day and remember that I love you very much. By the way, I’m easy to find… I am wherever there is love.

Love,
God

Are the “Seven Nursing Truths” Truthful? (Part II)

In a previous blog post, I the first 3 truths from a article appearing on the Reflections on Nursing Leadership magazine’s Website, entitled “What Nursing Leaders Know: Seven Truths From top Health Care Professionals.” This week, I would like to discuss truths 4-7.

4. The biggest value in being designated a Magnet hospital is creating a Magnet culture. We all know that culture trumps strategy and operations in a successful heatlh care system. By recognizing the components of the CHRISTUS brand and developing energy around our mission, values and vision, CHRISTUS has developed a strong foundation on which to overlay the 10 “magnets for magnet designation. We have crosswalked the requirement for success on our Journey to Excellance, Joint Commission, the Baldrige Award and Magnet stats and found they are all similar. Getting the award, however, is not the success. Creating the culture to sustain the successful behavior is!

5. Nursing needs a voice. We couldn’t agree more! If great nursing is a critical success factor, what they think is also critical. That is why the Chief Nursing Officers for our regions are members of the C-Suite, and the System Director of Quality is a nurse, along with the System Director for Nursing Education and Research.

6. Quality of care is based on confidence and competence. Although the statement is true, I believe a minority of nurses come out of their education and training programs with the all the confidence and competencies they need to be successful today. This is occurring for many reasons, which I will not articulate at this time. However, let me substitute or add another truth of my own:
The greatest mistake we made was to close hospital-based nursing schools because we saw them as a “cost center.” Because of the lack of sufficient on-the-job clinical training of recent nurse graduates, CHRISTUS Health has had to develop costly “nursing intern” programs for new hires to give them the confidence and competence our patients require today.

7. Nurse leaders need support now more than ever. Nurse leaders are no different than all other heatlh care leaders in this respect. We are all facing numerous challenges in a complex industry that is frequently changing. These complexities will only increase because of the lingering effects of the global economic recession and the changes yet to come as a result of health care reform.

To be successful, we all need to support each other so together as a team, physician, nurse, administrator, etc., are all successful, both in their personal and professional lives.

Message to the CHRISTUS Family

Yesterday evening, we distributed the following message to the members of the CHRISTUS family about our response to the tragic circumstances in Haiti.

CHRISTUS Health joins with all members of the Catholic health ministry to extend our thoughts and prayers on behalf of the people of Haiti, the Haitian community in the U.S. and our colleagues in country, who are responding to the humanitarian crisis unfolding in the chaotic aftermath of Tuesday's devastating earthquake.

Inquiries continue to arise from generous and compassionate CHRISTUS Associates and physicians about how CHRISTUS as a system plans to respond to this tragic event, while many have already made donations to the assistance organization of their choice. After prayerful consideration and careful discernment, CHRISTUS Health, on behalf of all its Associates, Sisters, physicians and volunteers, has decided to commit $50,000 to support the efforts of Catholic Relief Services, an organization that is already mobilizing relief efforts in the affected region. In addition, if you are interested in making a personal contribution, we would encourage you to consider one of the many disaster relief organizations accepting donations for hurricane relief efforts.

To assist you in this process, below is contact information for several Catholic-sponsored organizations that would welcome your support:
• Catholic Relief Services has told the Catholic Health Association that they are working to assure their staff are safe and to get an early assessment of immediate needs. They have posted a way to donate money to help buy supplies and transport them immediately. They are also moving other Relief Services personnel and supplies into the area immediately.
• Catholic Medical Mission Board has been assured that their staff in the region are safe, and are also mobilizing their relief efforts.
• Hope for a Healthier Humanity Foundation is targeting specific practitioners they have worked with in the area who have already been in touch listing the supplies that are critically needed. They will be shipping out medical supplies in the immediate future.

We will continue to work with the Catholic Health Association to monitor the situation, and have been advised that—in this early stage—it will be important to get an assessment of needs and get donations as soon as possible to purchase supplies and transport them, but that moving large numbers of well-intentioned relief workers into Haiti would be premature at this time. We will continue to work with all the agencies involved and share information about volunteer opportunities and timing.

Our Holy Father, Pope Benedict XVI, has appealed to the world to respond to the great need of the Haitian people. Please join us in offering the following prayer for the earthquake victims in Haiti.

Prayer for Haiti Earthquake Victims

Leader
O God of mercy, look with pity upon all those who have been left homeless, bereft, in shock, in the wake of this mighty act of nature in Haiti. Lord, in your mercy,

People
Hear our prayer.

Leader
Holy God, who fed your people in the wilderness, whose loving kindness is everlasting, lift the burdens of all who are weary from the search for food and refresh those who are parched from thirst. Lord, in your mercy,

People
Hear our prayer.

Leader
O Source of all consolation, comfort with the sure sense of your presence all who feel forsaken, and all those who have lost loved ones. Lord, in your mercy,

People
Hear our prayer.

Leader
Gracious God, you sent your son Jesus to bring sight to the blind, hearing and healing to all who asked, open our ears to all cries of affliction, and through us provide healing and help. Lord, in your mercy,

People
Hear our prayer.

Leader
Merciful God, you ask us to cleanse our hearts, to loose the bonds of oppression, and to repair the ruins. Pour out upon us the Spirit of your love and generosity that we might pour ourselves out for the victims of the earthquake in Haiti so that they, too, will know your generous healing power. We ask this through Christ, our Lord, Amen.
—Adapted from a prayer of the Evangelical Lutheran Church of America

Are the “Seven Nursing Truths” Truthful? (Part I)

Recognizing that our nursing professionals—their leadership, qualities and skill sets—are critical for the CHRISTUS Health ministry to reach the goals on our Journey to Excellence, I was most intrigued by a recent article appearing on the Reflections on Nursing Leadership magazine’s Website, entitled “What Nursing Leaders Know: Seven Truths From top Health Care Professionals.” It is most important for CEOs of health systems today to clearly understand, as the author tried to do through interviews, what top nurse leaders believe are the important issues in the nursing profession. After careful and reflective review, I thought it would be worthwhile to share my perspective on each of the truths. I will address truths 1-3 in this blog post and truths 4-7 in next week’s post.

1. A nursing shortage really does exist. I believe the shortage is often overstated. Whenever we have “nursing shortages” in a patient care delivery setting, we are able to have a contract nurse to fill the slot. I think that if all the nurses filling more lucrative contracted positions would take permanent employment somewhere, the perceived shortage would quickly diminish. In addition, because of the layoffs in many other industries due to the global economic crisis, more students are applying to nursing schools. When trained, having put forth the money and time, they will not leave a profession where there is much greater job stability.

2. We need a stronger model for developing and grooming nurse leaders. I agree 100 percent. Because most people leave organizations because they do not respect their “boss,” retaining good nurses depends on great nursing leaders. That is why CHRISTUS includes nurses in all our leadership training, including coaching and mentoring classes, the CHRISTUS Center for Management Excellence (along with a special section for nursing leaders, the CHRISTUS Center for Nurse Leaders), leadership academies and succession planning.

3. It is about the money. Our leadership team would say it is only partly about the money. The U.S. health care system is failing not because it has an unsustainable cost structure, but because it does not provide incentives to pursue a Journey to Excellence—like the one CHRISTUS is on—which commits them to achieving metrics on a balanced scorecard in four directions (clinical quality, service quality, business literacy and community value). Yes, having a viable business model to assure sufficient cash is most important, but only if this goal is used to support the three other directions driven by the ministry’s mission.

Please join me next week for my take on nursing truths #4-7.

Effectively Communicating with Credit Markets

On Dec. 30, the Healthcare Financial Management Association’s (HFMA) HFMA Wants You to Know Newsletter carried an article titled, “Effectively Communicating with Credit Markets.” I shared it with the CHRISTUS leaders as many had asked about the reasons for our successes this year in maintaining our credit ratings as well as in our refinancing of a significant portion of our variable debt.

In the article, Fred Hessler, a managing director of Citi’s Health Care Group, who has followed CHRISTUS Health’s journey since its inception almost 11 years ago, points out that “in today’s uncertain environment, access to low-cost capital may depend on your organization’s ability to clearly communicate its strategy for maintaining financial sustainability in the face of economic and regulatory challenges.” He goes on to identify three themes for effective communication and then uses the CHRISTUS Health presentation which Jay Herron, Senior Vice President and Chief Financial Officer for CHRISTUS Health, gave at the Annual Non-Profit Health Investor Conference earlier this year as a best practice for this effective communication process and summarizes why our presentation is noteworthy. I recently blogged about our experience at the conference, and you can access our entire presentation on HFMA’s Website here.

Although Jay and I have the honor and privilege of representing CHRISTUS Health by doing these presentations, it is important at this time to recognize the work of Melissa Williams, System Director, Debt and Portfolio Management for CHRISTUS Health, and Kim Reynolds, System Senior Director, Financial Reporting for CHRISTUS Health, who work diligently with their team to put these presentations together in a concise fashion that quickly connects the dots to our Journey to Excellence. Part of the CHRISTUS Heath brand since we began on February 1, 1999 has been transparency driven by open and honest communications of all we do. We are pleased that these values, which are sometimes difficult to maintain, are truly appreciated by those in the world who have been and are continuing to observe and monitor our visionary Journey to Excellence which has been evolving for over a decade.