Pediatric Care: Keeping It Close to Home

On the front page of today’s Richmond Times-Dispatch is an article about the demise of the collaborative effort between VCU and Bon Secours to build a freestanding children’s hospital. During my three years in Richmond, I have continually shared my perspective that this proposal was not viable including an Op Ed published in the newspaper on June 30, 2013.

HCA looked at this proposal multiple times to assess whether there was a compelling clinical and financial argument to centralize pediatric services in one place. After a comprehensive and systematic review of the data, it became clear that the proposal of collapsing services across the region to build an independent freestanding hospital would not improve the pediatric care in the market. Moreover, it would come at great financial cost. If the new hospital was built, it would require significant subsidies in perpetuity by the Commonwealth of Virginia (in other words, the tax payers), philanthropists, and cost shifting to insurance companies at the expense of insured individuals and companies across the region. The final conclusion was that the greater Richmond area only had the inpatient volume to fill a small, 100-bed hospital (less than half the size of most freestanding children’s hospitals) and, importantly, that the economics of the enterprise would not be viable for on-going operations. A hospital this size would not be able to offer the requisite pediatric sub-specialty services because patient volumes and research funding would not be there to support it. By comparison, Children’s Hospital of Philadelphia, a nationally recognized pediatric hospital, has more than 500 beds and serves a far larger metropolitan area.

The clinical case was also not compelling. Advocates for a new children’s hospital continually suggested that tertiary and quaternary (high-end) services would be available in the market because of the construction of a new facility. The reality is that 95% of pediatric services are available in our community today. HCA is proud to cover all geographic sectors of Central Virginia with 76 level 3 Neonatal Intensive Care beds, 12 Pediatric Intensive Care beds, 32 pediatric beds, and 8 Pediatric-Ready Emergency Rooms. These services are supported by highly skilled pediatricians, pediatric surgeons, pediatric sub-specialists, pediatric intensivists, and pediatric emergency room physicians. I believe these services have a long-standing history of making a difference in our community, including our most recent annual volumes of almost 1,000 Neonates, 45,000 pediatric ER patients, 6,500 newborn deliveries, 2,000+ pediatric admissions, and tens of thousands of outpatient visits. Building a freestanding children’s hospital would not have better served those patients who have unique medical challenges. Clinical evidence shows these patients are most appropriately served by national centers of excellence that have vast experience treating them.

So where does that leave us today? HCA Virginia, which includes Chippenham Hospital, Johnston-Willis Hospital, John Randolph Medical Center, Henrico, Parham, and Retreat Doctors’ Hospitals, and our free-standing ERs at West Creek and in Hanover are stepping up to give parents choices close to home in a coordinated and integrated fashion. Patients who come into our hospitals electively or emergently can trust our doctors, nurses, and other providers to give them the highest level clinical care in a compassionate manner. We will connect those patients to the best resources in the country, should it become necessary, but most often we are able to keep that care close to our patients’ homes and in coordination with those patients’ primary care physicians.

I look forward to moving on from the community discussion of a building a future children’s hospital to a conversation of building on the great success of the services in our community today in both a clinically smart and coordinated manner. I am proud of our care team, proud of our clinical results, and proud to be surrounded by clinicians who make a difference to the health and well-being of children every day.

CEO Video Blog

This week, Brandon & I do things a little bit differently with our first-ever video blog. Let us know how you like it in the blog comments.

Thank You to All of the Mothers!

This past Sunday was Mother’s Day. If you are a mother, or are still fortunate to have your own mother in your life, I hope you were able celebrate in some way. At Chippenham & Johnston-Willis Hospitals (CJW), we celebrated those mothers who had to work with a free meal in our cafeteria. I am fortunate to not only have a fantastic mother in Maryland but to also be married to a great mother of my three children. So this week, instead of talking about anything related to work, I thought I would just share some simple messages about their respective mothers from the young children of the administrative team at CJW. I have left the language in their exact words.

Max, Georgia, & Ava with mom, Holly

McManus Family

Max McManus (age 11): “She is nice and kind. She does so much for me. I love that every night she tucks me in and says I love you and that she cares so much about my diet and she makes sure I’m healthy. She is the best mom ever.”

Georgia McManus (age 9): “My mom is sweet, kind, and caring person. She is so supportive, especially when I need her most. She can also be very energetic person; she is always ready to have fun with her kids! She is an amazing and wonderful mother. My mom makes me happy and sometimes laugh a bit too when I am sad or depressed. I actually had a lot of my good memories with her (and also my father). My mom has played a very important role in my life and she always will. I am so glad she is my mother.”

Ava McManus (age 7): “She takes me where I want to go. She helps me with my homework. She helps me pick out what to wear. She supports me! She helps me when I’m hurt! She reads to me! She tucks me in at night! She cooks dinner for me! She snuggles with me! She cares for me every day!” (I like the exclamation points)

Gibby & Moss with their mom

Haushalter Family

Moss Haushalter: (Age 6) Son of Brandon Haushalter CEO of Johnston-Willis: “I love everything. I love kayaking with mommy and I love how she always thinks about me and takes care of me. I like how she always reads me stories before bed. I really like her hair.”

Gibby Haushalter: (Age 2): “I love mommy.”


Christianson Family

Caden Christianson (Age 6) son of Chippenham’s Chief Operating Office, Chad Christianson: “She is so sweet to me and she’s beautiful like a flower and she lets me go on rides and gets me Legos.”

Chance Christianson (age 3): “(I love her) because she is pretty and makes me pancakes.”


Hawkins Family

Dallas Drake Hawkins (Age 9) son of Roy Hawkins Johnston Willis’s Chief Operating Officer: “What I love most about my mom? Well I love the way she smells and especially the way her pillow smells. I love her crazy hair. I love her food mostly her wings. Oh and did I mention I love the way she treats me? I love that she takes me special places and surprises me. When she is on vacation, I always think about her and she always brings me back stuff. I will always love you mom. #1 mom — Bianca Hawkins.”

What is the best thing your children ever said about why they love their mother?

Caught in the Earthquake

Have you ever really thought about perilous experiences you hope to never experience? My guess is, if you have, being caught in a major earthquake would be one of them. Nancy Malhotra, Director of Trauma Services at Chippenham Hospital, recently found herself on the other side of the world during just such an event.

Nancy & Ajai

Nancy & Ajai

Nancy and her husband, Dr. Ajai Malhotra, a trauma surgeon at VCU Medical Center, flew to Nepal in April with plans to do an adventurous 18 days trek to Mt. Everest base camp. The plan was to join Nancy’s 23 year old stepdaughter who was finishing her work with a human rights organization in the capital city, Kathmandu. They flew into Nepal and proceeded on in a small plane for 70 miles to a remote airport in the mountain village of Lukla. Nepal2015 583 (2)After the long travel, they hiked 24 miles to base camp with the assistance of a Sherpa. The first part of the trip went off without a hitch, reaching the base of Mt. Everest after seven days. However, things dramatically change when they were on their way back, still 3 hours away from the Lukla airport. While crossing a 100 foot suspension bridge, 200 feet off the ground, the 7.8 magnitude earthquake struck. The epicenter of the quake was in Kathmandu but the impact was far reaching. You would think the best idea would be to get off a shaky primitive bridge and move to either side. However, with rocks tumbling off the mountainside, being on the bridge was the safest option. The bridge swung back and forth for almost a minute. They didn’t realize at the time how significant the damage was until they started the hike back to Lukla. As they passed through the small towns along the way it was obvious that they were abandoned as people relocated to the more populated villages to get help or see family members in Kathmandu. By the time Nancy and her husband arrived at Lukla all the flights were canceled and injured people started coming into the town for help. If you have followed the story in the media, you know that over 7,000 people perished, including 19 at base camp, from the avalanches. One of the women who died from an avalanche was a 49 year old who Nancy had come to know through the journey.

Plnn Hospital in Lukla

Plnn Hospital in Lukla

Nancy is also an acute care Nurse Practitioner; she and her husband immediately offered to help triage and treat the injured in Lukla. She worked in triage at the airport while her physician husband went to the small primitive hospital in town. Over 70 people were treated by the triage area within 3 hours. Their roles were to determine whether the patients would stay in Lukla or go to Kathmandu where more medical diagnostic and treatment options were available. The vast majority of the patients had head injuries. Many of the injured were Sherpas and guides. Unfortunately, they also received 6 bodies from base camp.

Nepal2015 695 (2)I asked Nancy how the experience changed her. She said, “While watching the landslides from the suspension bridge I thought I was going to die. I could see rocks falling down onto the houses below.” She went on to talk about the experience, “I didn’t know all the other hikers’ names through the trek, but because of the experience, we soon became a tight-knit family. It was hard to leave because we felt like we needed to continue to help. Unfortunately, the government of Nepal is resistant to help because of the political issues with China and India and funding doesn’t always get to those who need it most.”

Nepal2015 665 (2)She talked extensively about the beauty of the trip, “Mt. Everest base camp was at an elevation of 17,500 ft. It was a very tough climb and I hadn’t really trained for it. (Nancy also ran the NY marathon in 2011 without training.) I was on cloud nine making the trip and Nepal is one of the most beautiful countries. At 16,000 ft. you still have mountains towering over you. The people are incredibly gracious. They live on an average salary is $800/year and are totally dependent on tourist. “

Nancy and her husband are difference makers. They stepped up when they were needed and helped with their exceptional skills and compassionate hearts.

HCA stepped up too. The company is dontaing up to $1 million to support the Nepal earthquake relief efforts: $250,000 to Doctors Without Borders and MedShare International, a non-profit that redistributes surplus supplies and equipment to those in need, and will match up to $500,000 of donations from HCA employees and vendors to the American Red Cross.

I am proud of Nancy and proud to be associated with HCA.

Giving Back

I am a big believer that people who make a lasting and memorable impact do so because they not only identify the greatest needs but are also willing to step-up and engage in finding solutions. They have a passion for helping others and won’t rest until it is done. That is just what occurred when Chippenham’s Hospital’s Employee Advisory Group (EAG) recognized that some patients were coming in for health care and didn’t have the basic necessities like clothes and toiletries on their way out of the hospital.

If you aren’t familiar with the EAG, it is composed of staff across the organization who are focused on making CJW a great place to work and a great place to get care. They are informal leaders who have chosen to be involved and give voice to ideas that make a difference.

Linda Posenau

Linda Posenau

I asked Linda Posenau, one of our Laboratory employees and Chair of the EAG, what sparked the idea for a clothing closet for patients. She said, “The idea for the closet was a brainstorm presented to our Employee Advisory Group about 8 months ago. It was designed to mirror the charitable closets that local churches quite often do. I had read a post about a nurse here who went above and beyond and got clothes on her own for a patient to wear home. When the idea was presented [to the EAG] it took off…. others had seen the need too. Once we began to plan…we learned of Molly and Joann in the ED doing it on their own. They were living our motto of Our Patients. Our Priority. We want to create extraordinary experiences for every patient and contribute to something bigger. One of our guiding principles is Compassion and this small project was a small way to demonstrate how our team can make it happen.”

EAG Clothes ClosetThe EAG closet is being stocked as we speak with clothes and toiletry donations from staff. They need our help by continuing to get donations. I would like to challenge whole departments to consider making a collective donation. The EAG have asked for new clothes only to ensure our patients can walk out of our hospital comfortable and confident with clean clothes regardless of their situation or weather. They need men’s, women’s, and children’s clothes for all seasons. You can drop them off in security, or any of our security officers, and they will take them to the closet. If you know of a patient in immediate need please call the nursing supervisor or any case manager and they can access the clothing closet.

I appreciate the thoughtfulness of the EAG for developing a solution for very real problems that some of our patients experience at Chippenham & Johnston-Willis Hospitals.

Johnston-Willis Hospital Receives Their Comprehensive Stroke Center Designation

This week, Johnston-Willis Hospital (JW) received their Comprehensive Stroke Center designation. This is an amazing achievement that speaks volumes about the commitment of the doctors and staff at JW. I asked Brandon Haushalter, CEO of Johnston-Willis Hospital, to share his thoughts.

Brandon Haushalter CEO of Johnston-Willis Hospital

Brandon Haushalter
CEO of Johnston-Willis Hospital

Congratulations to the team for achieving the Comprehensive Stroke Center designation! I am proud to highlight our team who provides superior stroke care to our patients at both Chippenham & Johnston-Willis Hospitals. Johnston-Willis is only the 2nd recognized Comprehensive Stroke Center and the 1st non-academic community-based hospital in Virginia to receive such a designation. This accreditation is a public recognition of our team and the high-quality, time-critical intervention they provide for patients who are having a stroke.  This is an accomplishment that should make us all proud.

To successfully treat stroke patients, we require an incredible multidisciplinary team that CCSC logostarts before the patient even gets to the hospital and through rehabilitation. From the loved ones who initially recognize the warning signs, to the EMS providers who adeptly and swiftly reach the patient, to the ER staff and physicians, neurologists, lab technicians, CT Technicians and Pharmacists who move quickly to confirm stroke and promptly begin treatment, to the inpatient staff who provide ongoing care in our Neuro ICU and step-down unit, and to the therapists and nursing team who provide the longer term rehabilitation post-acutely, all work towards the same life-saving goal. JW has an incredibly talented and comprehensive framework of individuals who work seamlessly to provide top-notch care to our patients.

FASTIt is important that we all understand the basic warning signs of stroke and why it is so important that we treat promptly. The F-A-S-T acronym is an easy way to remember the key warning signs. I have also included below a link to the American Stroke Association web page. This site has excellent information that I encourage each of you to check out. They have great educational materials as well as videos discussing the warning symptoms, understanding stroke, and inspirational testimonials.

Thank you to the team for your dedication to providing life-saving stroke treatment! I hope you are all proud of this achievement, I certainly am proud of you.

Let’s Get Moving at Chippenham and Johnston-Willis

2dwfa8kYou can’t read a magazine, newspaper, or watch TV these days without seeing a story on the importance of healthy living. I’m not talking about fad diets and gimmick exercise equipment sold on infomercials – I am talking about no-nonsense practical ways to improve health through sensible diets and regular exercise.  Based on the feedback from our employees, we are taking this seriously at Chippenham and Johnston-Willis Hospitals, and launching the “Let’s Get Moving” campaign – a start to a long-lasting commitment to being healthy individually and as a community.

To jump start this initiative, you will see a few changes happening immediately:

  • Nutrition: We will be offering new combo value meals with healthy choices in our cafeterias, with clearly noted nutrition metrics for the primary dishes.
  • Take the Stairs: We will be showing the powerful effect of taking the stairs, rather than the elevator, by publicly posting the potential caloric benefit. Commitment to walking up and down one or two flights of stairs a day will build stamina and help everyone lose weight.
  • Walking Trails: Employees have asked for opportunities to walk or exercise at lunch or break time, so we will be designating areas at both campuses (a hiking trail at Johnston-Willis and a parking area loop at Chippenham) with noted distances and a few work-out stations incorporated where possible.
  • Gym Discounts: We have secured discounts at local health clubs for employees, as well as other fantastic health benefits. Access them via to start living healthier today.

Farmers-Market-foodsIn addition to the great benefits featured above, we have updated our HCA Rewards portal to include the H2U website, healthy recipes, fitness tips, and nutrition advice. We will also be starting exercise classes at both campuses (stay tuned for more details!), active participation in local charitable events (walks, runs, and cycling events) with CJW teams, and a continuation of our local farmer’s market with fresh fruits and vegetables on Fridays.

If you’re looking for some immediate motivation and activity tracking, below are some suggestions for app downloads on your smartphones:

Finally, our Employee Advisory Group surveyed employees and a few other ideas we are reviewing include:

  • A “biggest loser” style competition
  • Hospital-sponsored athletic teams
  • Health drives

How else would you recommend we encourage each other to be role models for a healthy lifestyle at Chippenham and Johnston-Willis? Please leave your feedback here on the blog, or contact me directly.