Sophie Harnage, infection control team leader
Researchers can spend years looking for ways to prevent the spread of hospital-acquired infections, but when it comes to keeping patients safe, it's often those who work on the front line who really make it happen. Just ask Sophie Harnage, RN, BSN, clinical manager of infusion services at Sutter Roseville Medical Center in Roseville, CA. Harnage heads a nurse-driven specialty team that has successfully prevented catheter-related bloodstream infections for more than two years at her facility.
"There's no question in my mind that this success isn't about me," she says. "It's an entire team that's made this happen."
That team uses a bundle created by Harnage and documented in the December 2007 edition of the Journal of the Association for Vascular Access. The bundle's steps include using peripherally inserted central catheters, ultrasound to select insertion sites, surgical-like coverage of both the patient and caregiver, a two-step cleansing and disinfection process, disinfection of the IV connector septum, and daily monitoring of the catheter line. The bundle was developed after years of observing what works—and what doesn't, Harnage says.
"What we've done is practice-driven, not research-driven," Harnage says. "The science is needed and it's important, but . . . it's not always applicable to everyday practice."
While each of the bundle's steps is important to the team's success, Harnage says her team's dedication to eliminating catheter-related blood stream infections and keeping patients safe is key.
"We at times lose sight of the talent, the input, and the guidance that these frontline nurses offer," she says. "Their commitment and their drive to make this successful keep it going."
The best thing about the work being done at Sutter Roseville? Harnage says it's simple, uncomplicated, and can be done at any hospital that is willing to give its staff the training and resources it needs to prevent infections. "When I take a step back and look at this bundle, it's simple, practice-driven, and something that any frontline nurse can implement at their hospital," she says. "It works because it's common sense."
Stan Brock, traveling caregiver
He is a big personality who lives a simple life with a single mission: providing healthcare to underserved, rural populations. Stan Brock founded Remote Area Medical in 1985 with the primary purpose of delivering airborne medical and veterinary help to the indigenous tribal groups of the Amazon, where he lived for many years. From there Brock's mission spread to Africa, Guatemala, and ultimately the United States, where now about 60% of the care the publicly supported, all-volunteer charitable organization provides is administered.
Since Knoxville, TN-based Remote Area Medical's inception, Brock has recruited and led volunteer teams of doctors, nurses, dentists, and veterinarians to deliver free care (at a value of more than $33 million) to hundreds of thousands of people around the world. But beyond the clinical care his organization provides, Brock, who co-hosted NBC's wildlife series Wild Kingdom in the 1960s and early 1970s, has certainly done his share to focus national attention on challenges in the U.S. healthcare system. Brock remains steadfast in his belief that if it were made easier for medical providers to practice across state lines, the system of free care that RAM created and practices could be replicated throughout America. "If doctors were allowed to cross state lines to provide free care for those in need and had some type of protection against malpractice, I think we could do this anywhere in the U.S.," he says.
Brock has testified on that topic in front of the U.S. House Ways and Means Subcommittee on Healthcare, and he also drafted a bill in Tennessee that was later passed into law called the Volunteer Healthcare Services Act, which allows volunteer medical personnel and veterinarians licensed anywhere in the United States to provide free care in Tennessee. Brock says a 1997 congressional resolution to let other states adopt the Tennessee model never got out of committee.
Scott Morris, minister and physician
Scott Morris, MD, realized at a young age that he was called to heal both the body and the spirit. Morris, an ordained United Methodist minister, is executive director of the Church Health Center in Memphis, TN, a faith-based organization that provides affordable healthcare for working uninsured people and their families. Morris founded the center in 1987 after coming to a harsh realization about the faith community's role in healthcare.
"I had read the Bible and read about healing the sick, and I looked around at what my church was doing, and there wasn't much to it," says Morris, who serves as associate pastor at St. John's United Methodist Church. "I thought there must be a way to reconnect people of faith to a true healthcare ministry that is tangible."
The center began with Morris and one nurse seeing 12 patients on the first day. The organization now cares for 55,000 people and offers myriad services beyond the clinic itself. The MEMPHIS Plan is the center's employer-sponsored healthcare plan that uses donated services from physicians. Hope & Healing is an 80,000-square-foot wellness facility that sees 120,000 visits per year. And the center's Faith Community Ministries program trains "congregational health promoters" to be healthcare liaisons in their congregations.
Morris designed the Church Health Center model to be reproducible; the center holds "replication seminars" to help caregivers in other cities launch their own facilities. Roughly 20 organizations in Tennessee, Georgia, Texas, Missouri, and other states have been created based in large part on the Church Health Center model.
The center's latest endeavor: an online magazine and social networking site, www.hopeandhealing.org, that launched in November and addresses "anything about faith and health," Morris says. But even as his organization expands and more caregivers follow the path he has set, Morris remains focused on a longtime central theme—that healthcare should be more than curing physical ailments. "Life for life's sake doesn't make any sense—it's not just about avoiding disease," he says. "True healthcare includes the life of meaning, not just breathing in and out."
Jon Kingsdale, Bay State reformer
Jon Kingsdale, PhD, once dreamed of being a history professor. Now he's not just teaching history—he's making it. Since 2006, Kingsdale has been executive director of the Commonwealth Health Insurance Connector Authority, which oversees Massachusetts' healthcare reform programs that improved coverage access to 440,000 newly insured residents. The effort is being watched by healthcare leaders across the country, and Kingsdale is excited about working on the challenges that arise from being first in the nation. "It's like drinking champagne from a fire hose," he says.
The connector authority oversees two programs: the subsidized Commonwealth Care and unsubsidized Commonwealth Choice. The programs' popularity has been both a blessing and a curse. The programs have contributed to an overall increase in insured lives by 7% of the state's population and revamped the individual insurance market by bringing thousands of healthy people into the program, which has decreased premiums and improved coverage, he says. But the especially popular Commonwealth Care program has brought about higher-than-expected program costs.
A large part of Kingsdale's work is developing and maintaining relationships with the multiple stakeholders with varied interests, including business leaders, labor leaders, healthcare officials, legislators, and state agency leaders. The connector authority reaches out to the commonwealth's 192,000 employers and 6 million citizens to both educate and engage the uninsured to enter the programs.
The result has been an educated and largely supportive public. Kingsdale says a recent study showed that 93% of Massachusetts residents understand the healthcare reforms while more than 70% of employers and likely voters support the initiative. Having a broad coalition and the support of the State House has been critical; states eyeing such reforms must remember that a divided legislature won't provide the support needed to back these kinds of programs, he says. "To do something significant like this on a narrow partisan vote, I think, is very, very difficult."
Tammy Roehrich, volunteer EMT
Access to healthcare in rural America and underserved regions is spotty at best. Sure, a hospital may be an hour away, but what happens when you have a car accident or heart attack in the middle of the night? Who's going to come to your aid?
Often the answer is a volunteer emergency medical technician like Tammy Roehrich. Ambulance service organizations in rural areas don't have the resources to pay paramedics, nurses, or EMTs, so their viability depends on community volunteers. In North Dakota, 90% to 95% of ambulance services are volunteer organizations, says Roehrich, a resident of Fessenden, ND—a town of about 500 people. Roehrich has been volunteering on the Fessenden ambulance service for 17 years. "I just saw a need in the community. I took a CPR class, loved it, and just continued on," she says.
The Fessenden ambulance service has 15 members from all walks of life. It provides service 24 hours a day, seven days a week, 365 days a year. It services two hospitals—one is 20 miles away and the other is 35 miles away—and patients are brought to whichever facility is the closest to them. They respond to about 50 calls per year, and the service is strictly a volunteer organization.
Fessenden has physicians who come to the community twice a week, but if someone gets sick in the middle of the night—especially a member of its elderly population—they have no access to care, Roehrich says. "We are it."
Volunteer EMTs are becoming an endangered species. Many ambulance services are struggling to recruit enough volunteers to keep their service open. "Volunteerism today isn't what it was 25 years ago," says Roehrich. The Fessenden ambulance service recently offered a free basic EMT community class to bolster its numbers. "You ask, you beg, you plead," says Roehrich. "You show people the need and say, 'We need your help.'"