11/20/07

THE IRELAND REPORT

The Retreat Women’s Health Center:

Goshen General Hospital’s Gift to Women

Goshen, Indiana is a small, rural community in northern Indiana. While there are several large metropolitan areas nearby (Chicago, Detroit, and Indianapolis are located less than 200 miles away), this community of 29,000 takes pride in its small town charm and its Amish and Mennonite heritage, a heritage that has strongly influenced healthcare services in the community.

Goshen is not the type of place where one would typically expect to find nationally recognized healthcare services, but that is exactly what consumers have available to them at Goshen Health System. Goshen Health System is a Clarian Health Partner and includes Goshen General Hospital, Park Home Medical Equipment, Prime Care Physician Network, Indiana Lakes Managed Care, The Center for Cancer Care, Team Bariatrics, Healthy Generations and The Retreat Women’s Health Center.

Goshen General Hospital is a 116 bed not-for-profit hospital with a very strong mission "to improve the health of our communities by providing innovative, outstanding care and services through exceptional people doing exceptional work." Ten years ago, the hospital found itself dealing with the same struggles as most healthcare organizations – rising costs and decreasing reimbursements. While most organizations solve these problems by cutting staff and programs, Goshen chose a different approach that brought a significant turnaround to the organization. New CEO James Dague, FACHE, and his leadership team adopted the philosophy and approach detailed in healthcare strategist Clay Sherman’s book, The New American Hospital and its accompanying program, The Uncommon Leader. Sherman’s basic premise is that the people who work in an organization know how to best run the organization and how to make improvements. Expect people to make improvements, and they will, if you give them the opportunity to do so.

All existing leadership personnel went through Sherman’s The Uncommon Leader Program. All new leaders at the supervisor, coordinator and director level now go through the program. Employees were renamed "colleagues", but rather than put a new name to an old role, the concept of co-worker as "colleague" was actively embraced within the organization. Colleagues have numerous mechanisms in place to bring about organizational improvement. "Out of the box" thinking is encouraged, and colleagues are rewarded for bringing new ideas to the table. These significant philosophical changes in attitude and work habits transformed the hospital into a powerhouse organization that is both receptive to and able to implement change quickly. The hospital is proud of the fact that because of its dramatic changes, it has weathered the difficult economic times of the past decade without resorting to layoffs. In June 2004, an independent survey firm ranked the work force at Goshen Health System #1 in the category of "Concern for Patient Care". Goshen Health System was also ranked in the top 10% of all healthcare organizations surveyed for employee satisfaction regarding the work environment.

At a time when most organizations were cutting programs, Goshen General Hospital grew. During strategic planning sessions in 1997, the system’s Board considered several new initiatives, among them cancer services and women’s health services. The Board decided to pursue cancer services first (a decision that would ultimately have a very positive impact on women’s health), with women’s health to follow.

By 1999, The Center for Cancer Care at Goshen Health System was operational and in the process of developing a national reputation for innovation and excellence so the energy turned to women’s services. Administrators began working with consultants and quickly learned that a physician champion was the key to the development of a successful women’s health center. At the time, no physician champion was identified, and momentum stalled, until the day that breast surgeon Laura Morris, MD, MBA, FACS showed up to interview for a position in the Cancer Center.

Dr. Morris was interested in Goshen’s Cancer Center because she wanted to practice in a place that integrated complementary therapies into traditional cancer care. "Goshen is a very small community. Not only is there a large Amish population, but we also have other conservative ethnic and religious groups in our community, and these groups tend to have more interest in complementary treatments." Recruited from a faculty position at a major university to come to Goshen as a breast surgeon, Dr. Morris mentioned during her interview that she had completed her MBA and hoped to eventually become more involved in women’s health. "Suddenly, people began talking about Goshen’s vision for women’s health services. The recruitment process changed – they asked me to consider a dual role that not only gave me the opportunity to treat women with breast cancer but also to become the physician champion for their women’s health project."

Dr. Morris accepted the challenge and together with hospital leadership worked aggressively on the development of a women’s health center for Goshen General Hospital. The center, named The Retreat Women’s Health Center, opened its doors on January 6, 2003. Dr. Morris is The Retreat’s medical director, a role that involves development and oversight of all clinical and educational programs and integration of these programs and services into primary care practices. She also practices at The Retreat, seeing women with a wide range of breast problems and concerns.

Laurie Busby, RN, MS, is The Retreat’s executive director and is responsible for daily operations, finances, strategic planning and marketing. She joined Goshen Health System two months prior to The Retreat’s opening and credits board members, administrators and Dr. Morris with having an early vision and commitment to improving care for women in the Goshen community. "As key players worked to develop The Retreat, they looked at several factors. Profitability and cash flow were very important and were carefully examined; however, greater influence came from identifying that we were missing many opportunities to offer services to the community. The Retreat allowed us to put our mission into action and fill significant service gaps, which not only helps our system through market share growth but also improves the health of women in our community."

The Retreat Women’s Health Center is a 20,000 square foot facility that features a blend of healthcare and retail services.

When space constraints prohibited The Retreat form being located on the hospital campus, a partially vacant local shopping mall located just a couple miles from campus was purchased and became The Retreat’s home. The mall had an existing conference center and restaurant, and both were integrated into The Retreat’s services

Women who use The Retreat for care are greeted by the scents of fresh baked bread and gourmet coffee upon entering the facility. Services are comprehensive, unique and designed to appeal to women of all ages. The Retreat’s color scheme and décor were thoughtfully and carefully planned to be very feminine, pleasant to the eye and appealing to the senses. The Retreat colleagues wear lavender, sage green, soft yellow and coral scrubs to reflect the facility’s color palette. Women who visit The Retreat consistently comment that they feel they are in a lovely, sensitive and caring environment. The Retreat is a unique place that was designed for women, by women and its run by women.

The Retreat is committed to its customers and routinely monitors customer service. Its satisfaction scores rank among the top 1% of hospitals across the nation, according to the Press Ganey and Associates database. Press Ganey is the healthcare industry’s top satisfaction measurement firm and is committed to helping clients measure patient satisfaction in order to improve quality of care. Since its first Press Ganey assessment in April 2003, The Retreat has consistently achieved satisfaction scores in the 99th percentile.

Breast Health Services

The Retreat’s breast care services are comprehensive and encompass prevention, diagnostics and treatment. The Retreat features the area’s only full-field digital mammography system, which both Dr. Morris and Busby believe will be the industry standard in the next few years.

"Digital mammography is fast and requires fewer callbacks," explains Busby. Dr. Morris adds, "Offering digital mammography demonstrates our commitment to giving women the latest and best technology available on the market."

In addition to scheduled mammograms, The Retreat does approximately 90 walk-in mammograms a month. "We don’t want a woman to avoid getting a mammogram just because she doesn’t have an appointment" says Busby, "so we do everything possible to accommodate her." There are private changing rooms directly connected to the mammogram room and comfortable capes that coordinate with the facilities overall décor, deodorant, powder and hairspray are provided. Women are never left alone in the room during the mammography process and digital mammography allows women to see their breast images as they are recorded. The Retreat uses its "Breast Friends" program to encourage women to get their mammograms done with friends, making the process less intimidating and threatening for some. "Breast Friends" schedule their mammograms together. After registering, each woman receives a 10% discount coupon for The Retreat’s Park Boutique and a "buy one, get one free" drink coupon for the Café at the Retreat."

A commitment to same-day-service differentiates The Retreat from other programs. If a woman wakes up and discovers a lump in her breast, she can be seen at The Retreat the same day. If Dr. Morris determines the lump needs to be biopsied, she performs the biopsy that day, and the on-site pathologist provides a preliminary report within minutes. According to Dr. Morris, "If you look at the national statistics of women who have mammograms that ultimately lead to breast cancer diagnoses, it can take up to 40 days from the time of the first mammogram to the time a woman finally sees a surgeon and receives definitive treatment. The biggest anxiety related to the mammogram is just not knowing. Getting results the same day, and having a work-up and the opportunity to see a breast surgeon right away is very important to women, and that’s why The Retreat provides same day service."

The Retreat is one of approximately 40 centers nationally that offers the cutting edge technology of ductoscopy to women who are at high risk for developing breast cancer (due to family history or other factors) and /or to women who have nipple discharge. Ductoscopy, a new procedure developed approximately two years ago, involves inserting a hair like scope through the nipple and into the ducts to check for abnormalities. While a mammogram detects growths of about 5mm, ductoscopy can detect a growth of 1 mm. Ductoscopy provides surgeons with a way to find tiny lesions that they have been previously unable to see. While Dr. Morris doesn’t see ductoscopy becoming a mainstream diagnostic tool, she describes it as another effective weapon in the arsenal to fight breast cancer. Cryoablation, radiofrequency ablation and brachy therapy, tools that one would expect to find only in large cities or universities are other examples of cutting edge technology available at Goshen Health System through the Cancer Center and The Retreat.

Prior to Dr. Morris’ arrival at Goshen, mastectomies were the most common surgical treatment for breast cancer patients. "Women who didn’t want a mastectomy usually went somewhere else to care." While there are three other surgical oncologists on staff, Dr. Morris now sees 80+% of the breast cancer patients, something she attributes to two factors: she is a female surgeon and is fellowship trained in breast oncology. Busby takes it further, explaining "Dr. Morris is an amazing woman and an amazing physician. In addition to providing clinically excellent care, she provides it with a level of compassion that one doesn’t usually associate with a surgeon. Women are comfortable with her because they can tell she really cares about them as whole people, not just as a ‘breast cancer patient’."

Women can see Dr. Morris at The Retreat or at her office in the Cancer Center. Once a week, a Breast Interdisciplinary Clinic is offered to women with newly diagnosed breast cancer. A woman is able to meet individually with a medical, surgical and radiation oncologist to discuss her treatment options. The team then meets to review each case and make recommendations or treatment protocols. Says Dr. Morris, "The benefit to the patient is that she sees everybody in one place, instead of going to three different offices and hearing three different opinions. For the physicians, we get to work together to come up with a consensus opinion about the best course of treatment for a woman. Our complementary therapy team is also involved in this process, so everybody, including the patient, is on the same page about what is going on."

Breast Health Specialist Sharee Hartman, RN, BSN, works with Dr. Morris’ patients to coordinate their care, provide support, assist with education, provide genetic counseling and interact with physicians. Hartman conducts breast self-exam sessions, coordinates the "Look Good, Feel Better" program with the local American Cancer Society and facilitates a monthly breast cancer support group. She also coordinates Heart String Sisters, a program specifically developed by Goshen General Hospital to link women with new breast cancer diagnoses to other women who have had breast cancer. This program carefully matches women according to age, stage of cancer and specific treatment recommendations. Hartman explains, "The matching process is very important to the success of this program, because it ensures that women with similar circumstances are working together." Hartman is also a navigator, coordinating follow-up care for patients with abnormal mammograms or breast ultrasound results to ensure patients receive timely care.

Focus on Healing classes are offered periodically at The Retreat. This therapeutic dance and exercise class was developed by breast cancer survivor Sherry Lebed Davis as a way to provide women with support, empowerment, and socialization during the breast cancer recovery process. Dr. Morris, who is the first physician in the country to become a certified Focus on healing instructor and is the only certified instructor in Indiana, teaches the classes. Originally intended for any woman who had breast surgery, node dissection, radiation, chemotherapy, or suffered from chronic fatigue, Dr. Morris expanded the class to include women who need movement and range of motion therapy, such as those with fibromyalgia and arthritis. "My undergraduate degree is in Musical Theater and Dance, and I am very interested in the benefits of movement therapy. As soon as I saw Focus on Healing, I knew that we had to bring these classes to The Retreat. The program takes the place of a support group, and does a wonderful job of boosting a woman’s physical and emotional state during the recovery process." For more information on Focus on Healing, go to www.focusonhealing.net

Additional Imaging Services

The Retreat offers Lunar Bone Densitometry for the detection of osteoporosis. The Retreat is the only place within several hundred miles to offer General Electric’s Voluson 4-D ultrasound technology. 4-D ultrasound provides the highest quality imaging results in obstetrics, breast imaging, interventional urology and general imaging. Women who receive pregnancy ultrasounds at The Retreat are given a complimentary CD or videotape with their babies’ pictures. The Retreat is a national show site for GE Medical Systems for women’s imaging services and frequently demonstrates its state-of-the-art technology to professionals who might be interested in purchasing similar equipment.

A new Outpatient Imaging Center recently opened on The Retreat campus. While not specifically dedicated to women, the additional of the Center assists The Retreat in providing the one-stop shopping experience that is so important to its community’s women.

Complementary Medicine

The Retreat offers a full range of services from which women (and men) can choose. A naturopathic physician sees patients for one-on-one consultations and also conducts very well attended fibromyalgia classes. Comprehensive massage therapy services include medical massage, prenatal massage, cranial sacral therapy, and relaxation massage. A specially trained physician offers acupuncture twice monthly and an aromatherapist utilizes the "m" technique for the bodily application of essential oils. Those interested in Yoda can attend group classes or schedule one-on-one sessions. Personal trainers are also available and work closely with the medical massage therapists to help meet the needs of clients. All complementary therapy providers are independent contractors, and all services are fee for service.

Other Services

The Retreat offers a behavioral-bases urinary incontinence program that was previously offered through the Center for Rehabilitation and "women were self conscious going there for care" says Busby. When they come to The Retreat, nobody knows the purpose of their visit, so there is an added level of comfort. A clinical social worker provides outpatient therapy, and women are also more comfortable receiving these services at The Retreat due to an increased sense of confidentiality. A female plastic surgeon, Alissa Shulman, MD, sees patients on a part-time basis at The Retreat for cosmetic and plastic surgery services.

The Retreat sends out 35,000 quarterly newsletters to women who are segmented into AM (younger) and PM (older) markets, with each market receiving a newsletter targeted to specific healthcare needs. A comprehensive health information center provides books, internet access, video and other media on a number of women’s health topics. A full time health education coordinator, Jennifer Haney, BS, helps patients and families better understand health conditions and/or diseases. In addition to scheduling all community education programs, Haney conducts one-on-one education sessions when necessary. She also created eight primary teaching packets consisting of information on commonly requested topics. If a physician identifies a patient with an educational need, he/she fills out a "prescription" for education and sends the woman to Haney. The Retreat offers a variety of support groups on topics of interest to women and also provides meeting space for community-sponsored support groups whenever possible. The Park Boutique: A full array of health and wellness products, including lactation supplies, breast prosthetics, wigs and gift items are available at the Park Boutique. The Boutique carries a variety of complementary medicine items, such as bands, balls, yoga resources, books and vitamins and supplements selected by the naturopathic physician. A Certified Prosthetic Fitter, Deanna Cross, manages the Boutique.

The Retreat Café and Conference Center: The Retreat Café sits just inside the entrance to the facility. A local catering company, Bread and Chocolate, runs the café and specializes in excellent, homemade food, gourmet coffees, homemade pastries, cookies, etc. Breakfast and lunch is served on the premises or is available "to go". A 250 seat conference center is available for educational programs, meetings, weddings and large events and along with The Café, is a way to bring people to the facility that might not otherwise come.

A Recipe for Success

When asked to comment about the success of The Retreat Women’s Health Center, James Dague, President and CEO of Goshen Health System said, "When we began the development of our women’s services program, the women in our community told us what they wanted. We listened. The Retreat encompasses state-of-the-art technology with educational and support services. It was designed by women, for women, and has truly fulfilled our mission of providing innovative, outstanding care to the communities we serve."

Busby describes The Retreat as a place where laughter is frequent, teamwork is the standard, and genuine respect for colleagues is the norm. "This is a delightful group of people. Turnover is very low, and it’s a fun place to work. Every person is cross-trained to do at least two jobs, helping each of us have a deeper understanding of others’ jobs. Women who come to us can feel that we truly enjoy what we do, and it makes them feel good about receiving care here."

Dr. Morris continues, "The attitude and approach to care we bring to The Retreat is intentionally unique. One mistake that healthcare providers routinely make is to treat the disease and not the person. At The Retreat, we’re not treating a breast cancer. We’re treating a WOMAN who has breast cancer. There’s a distinct difference in the approach, and women who come to us for care can feel the difference. We are also very committed to treating women as we want to be treated. This means ALL women, regardless of their socioeconomic status or community connections, are treated the same. And finally, we believe that if people come to us for care, they should receive their test results promptly and professionally. They shouldn’t have to sit around waiting for us to do our jobs. The Retreat is special because it is a place where women can go and feel comfortable while receiving excellent care delivered by outstanding people."

Busby’s advice for those organizations that might be considering an initiative similar to The Retreat: plan, plan, plan. "Our process involved physicians, staff, and outside consultants. We asked women what they wanted, and we listened to them. We weren’t and still aren’t afraid to think differently." Dr. Morris continues, "Be realistic about your proforma. Make sure you have strong administrative and board support and understand that if you don’t have a physician champion for the project, someone who is willing to actively work with other physicians, you’ll have a tough time getting buy-in from your medical staff."

The Future

Busby and Dr. Morris see The Retreat as a definite success, well worth the time, money and effort it took to develop. At only 18 months old, The Retreat still has a lot of growing to do, and Dr. Morris and the rest of The Retreat staff are excited about the opportunities that lie ahead. The Retreat will soon offer menopause and osteoporosis clinics, incorporating traditional and complementary treatments. This fall, a nurse practitioner will begin providing primary care services for women, including a "busy woman" physical. Busby and Dr. Morris expect continued growth of programming that meets the specific needs of women.

As she looks to the future, Dr. Morris envisions The Retreat as the place women think of first when they have a health concern. She sees a facility that is respected for high quality service and compassionate care provided in an inviting, comfortable setting. Future landscaping plans include the creation of a beautiful park-like environment, complete with exercise trails, gazebos, and fountains. Dr. Morris eagerly anticipates the day when the women of Goshen, Indiana and the surrounding communities can’t imagine choosing anyplace but The Retreat Women’s Health Center for their healthcare services.

Learn more about The Retreat Women’s Health Center by visiting www.womans1.com