Health Care Heroes 2009

Washington state has long ranked among the nations leaders when it comes to state-of-the-art health care. But who are the dedicated professionals helping to make this state such a unique place for the health care industry and life sciences to flourish? And more to the point, who are the best of the best?

Identifying those worthy few who improve coverage and create medical miraclesnot only for people in this state, but also in some cases around the worldis the reason that Seattle Business developed this award program.

In the fall of 2008, a panel of judges from across Washington, representing different areas of emphasis in health care, began the nearly impossible task of picking the winners of our first annual Leaders in Health Care award.

Because there were so many talented professionals and organizations that deserved honors, the experts divided the award into eight categories, recognizing top health care executives from metropolitan and non-metropolitan regions, the states outstanding health care volunteer and a lifetime achievement award, to name just a few.

Health care professionals, hospital administrators and business leaders from across the state submitted nearly 100 nominations. And the truth is: Virtually all candidates were worthy of the awards and deemed impressive by the panel. The judges spent many hours combing through worthy applications. But rules are rules and only one winner was allowed for each category. In some cases (though not all), the panel even chose to name two runners up.

Here are the winners of the Leaders in Health Care and Life Sciences 2009.

Lifetime Achievement Award

Dr. Michael Copass, Former Director of Emergency Services, Harborview Medical Center

Harborview Medical center is a known as a magnet for dedicated physicians, nurses and other health-care providers.

During the last three decades, dozens of medical luminaries have spent their careers delivering health care here and, in the bargain, turning Harborview into a legendary institution.

Yet of all the physicians, past and present, who have helped Harborview shine, a neurologist named Michael Copass may have done the most to help the hospital develop its world-renowned reputation.

Dr. Copass took over the emergency department in 1973. For 35 years, he presided over its evolution into the place to which patients want to be taken when an urgent crisis threatens their lives. Not only does Copass direct the paramedic training for Seattle Medic 1, but in 1982, he helped found Airlift Northwest, the swift system of airborne ambulances serving a region stretching from the northern tip of Alaska to the Little Bighorn in Montana. Hes also a University of Washington professor of medicine and oversees the training of newbie physicians in their residencies.

And yet these titles are mere scribbles on the mans resume. To understand Michael Copass importance in the local health care field, talk to other doctors.

Hes been described as a combination of General Patton and Albert Schweitzer, says David Rosell, a physician who trained under Copass and still devotes part of his work week to the Harborview emergency room. I think it sums him up as well as anything.

Rosell says hes never seen anyone who matched the Copass work ethic: at the ER by 6 a.m. and on the job until 8 or 9 at night. Then hed drive home in his BMW and sit by the phone, directing care of complex traumas all night long. Mike Copass put Seattle on the map as the place to be if you had serious trauma, Rosell says.

Beyond this dedication, Rosell says, Copass made sure Harborview gave everyone the best care, especially if they were broke or drunk or otherwise outcast.

He created an environment where some of the best care is providedand to everyone, Rosell explains. Homeless people, people with drinking problemsthey know that they are going to be treated like kings as soon as they come to the ER. Thats Mikes real legacy. Hes passionate about giving everyone the absolute best care.

Copass would apply his high standards to young doctors, and youd better live up to those standards or, in his own unique way, he let you know youd screwed up, Rosell remembers. When I first started working for him, I was really afraid of him. But he forces you to be rigorous. He doesnt allow shortcuts. He forces you to be a better doctor.

Last Nov. 17, Dr. Copass announced his retirement as director of emergency services and as president and medical director of Airlift Northwest. But he couldnt quit completely. He remains in charge of paramedic training for Seattle Medic 1.

Rick Rapport, a neurosurgeon who practiced at Group Health for 29 years and recently became clinical professor of neurosurgery at the UW School of Medicine, did part of his residency under Copass in the 1970s. He puts the Copass legacy in a larger context for the local community.

All of medicine is composed of the fine balance between technical possibility and the desire to treat others as one hopes to be treated, Rapport says. The physician-moralist Edmund Pellegrino calls this professional obligation the voluntary self-imposition of higher-than-ordinary standards.

It is this care of helpless, injured patients, Rapport says, that perhaps requires the greatest expression of this responsibility. For all of the nearly 40 years Ive known Mike Copass, he adds, no one felt this requirement more deeply, tried harder to treat people with both technical mastery and humanistic reverence, and demanded the same diligence from all of those around him than Mike did.

Outstanding Health Care Professional

Dr. David Flum, Associate Professor, Department of Surgery, University of Washington

In a region with so many world-class physicians and medical researchers, singling out one person for outstanding performance was not only daunting for the judges but also daring.

Still, after lengthy discussions and much deliberation, candidate David Flum simply could not be passed over.

As director of the University of Washingtons Surgical Outcomes Research Center (SORCE), his mission is to support the use of data based on real surgical outcomes to improve the quality of surgical care. So far, 30 hospitals across Washington state are participating in a Surgical Outcomes Assessment Program he oversees.

Dr. Flum is bringing to the world of surgery the kinds of rigorous evidence-based assessments of procedures that other segments of medicine have long depended uponbut which, ironically, surgery has lacked.

For example, only after clinical trials and approval by the Food and Drug Administration can doctors place appliances such as pacemakers or stents into their patients. However, similar requirements do not exist for appliance-free procedures; even major surgical procedures such as liver transplants are pretty much up to the practice and whim of the individual surgeon.

Sometimes surgeons start doing these things before they really know if [the procedures] work, says John Slattery, the UW School of Medicines vice dean for Research and Graduate Education. Instead of evidence, surgeons base their choices on past training, what their peers are doing in similar circumstances, what seems logical and, in some instances, what produces the most revenue. Of course, quality suffers.

Case in point: When doctors learned how to remove arterial plaque from the carotid artery that carries blood to the brain via the neck, some physicians immediately assumed they could lower patient risk for stroke by going in and, using a miniature version of a roto-rooter, reaming out the artery and improving blood flow. As these doctors told their colleagues of the procedure, more and more began roto-rootering their patients necks.

Unfortunately, as the profession learned later, carotid endarterectomies, as the procedures are known, turned out to cause strokes and other horrors to some patients with certain conditions.

It is this sort of harm Flum seeks to prevent or at least reduce.

He faces unique challenges. Unlike clinical drug trials, where patients can be screened and given drugs in exact amounts, variability in random operating rooms cannot be easily controlled. Every hospital sets different standards and requires its own procedures.

Of course, every surgeon is unique, with varying sets of skills, temperaments and beliefs. Taking these factors into account is Flums specialty.

Currently, SORCE is leading a statewide initiative aimed at getting hospitals and physicians to complete a surgical checklist before every surgery. With financial support from the Life Sciences Discovery Fund, Flum works on ways to assess procedures at different hospitals, link these operations to outcomes, and help surgeons pull their beliefs and practices closer in line with todays key medical tenet: evidence-based medicine.

Were trying to change the cultures of these different operating rooms by comparing the data from different hospitals across the state, says Flums boss, Carlos Pellegrini, chair of the UWs Department of Surgery. Flum has found that there was a tremendous variation in processes between different hospitals in the state, and that lack of standardization of processes actually yields a poor result.

Given the often-legendary egos of the surgeon class, the job is not an easy one. But Pellegrini says the change Flum inspires is starting to occur, and it already has led to healthier surgical outcomes across Washington.

Runners-Up

• Henry “Hank” Kaplan, M.D., medical oncologist, Swedish Cancer Institute
• Richard N.W. Wohn, M.D., M.B.A., founder and president, South Sound Neurosurgery PLLC

Outstanding Health Care ExecutiveMetropolitan Region

Diane Cecchettini, RN President and CEO, MultiCare Health System in Tacoma

Compared to her fellow health care executives, Diane Cecchettinis career path has taken some unique directions.

She began in the medical profession as a pediatric nurse at UCLA, evolved into a flight nurse during the Vietnam War and eventually to a troop commander during Desert Storm. For the past 10 years, she has been CEO of Tacomas MultiCare Health System.

While Cecchetini has become a recognized leader in the local and national health care sector, she has never forgotten her roots. Shes a servant leader, and she really does lead by serving, says Dr. Robert Roth, a pathologist and member of MultiCares board of directors. She has brought a human touch to this organizationand it was needed.

Under Cecchettinis leadership, MultiCare has grown to become the largest health-care system in south Puget Sound and, with 8,500 employees, the largest private employer in Pierce County. MultiCare chose to become an early adopter of electronic health records, earning Cecchettini the Modern Healthcare CEO IT Achievement Award one of only three CEOs nationally to receive such recognition.

As president of the Washington State Hospital Association from 2005 to 2007, Cecchettini pushed patient safety to new levels of quality, launching a statewide program based on evidence-based protocols. At MultiCare facilities alone, the initiatives pushed by Cecchettini have prevented the deaths of 162 people, according to in-house statistics.

Cecchettinis peers at the state hospital association took the unusual step of insisting she stay on for a second consecutive term as president. She founded and chaired the Patient Safety subcommittee, and successfully inspired 100 percent of Washingtons hospitals to join the Institute for Healthcare Improvements 100K Lives Campaign, resulting in quality improvements across the state and even the nation.

Cecchettini is known for her openness and interest in keeping employees informed on issues with a regular series of employee forums each quarter. She also instituted an employee gain-sharing program, which, Roth says, can add up to several thousand dollars per salaried employee each year.

Lois Bernstein, MultiCares senior vice president for community services, who has worked in health care since 1980, says Diane Cecchettini is by far the most amazing CEO Ive ever worked for. In fact, I came to MultiCare specifically to work for her. She brings her nursing expertise to hospital administration. With Diane, its always, Whats best for the patient? And thats a great thing.

Runners-up

• Rick Cooper, CEO, The Everett Clinic
• Johnese Spisso, clinical operations manager, UW Vice President for Medical Affairs

Outstanding Health Care ExecutiveNon-Metro Region

Scott Adams, CEO, Pullman Regional Hospital

Joe Pitzer, a Palouse realtor and also vice president of Pullman Regional Hospital, says Scott Adams should have a hall full of awards, but hes just not good at accepting them. Hes too humble to apply for anything.

And probably too busy. For the past 16 years, Adams has led this small, rural hospital through not only a period of unprecedented growtha 40 percent increase in patient volumes, a 100 percent increase in full-time employees and a nearly three-fold increase in overall revenuebut also transformed the organizations management structure, jettisoning the traditional, top-down hierarchy and nurturing an employee-driven culture of personal responsibility and decision making.

Since Ive been on the board13 or 14 yearsnot one member of his administrative team has left, Pitzer adds. Whats that say about the guy?

Adams refused to simply mandate such progressive policies. Instead, he spent years helping his employees take hold of the hospitals reins and encouraging a philosophy in which personal change precedes organizational change.

The result? In 2008, Modern Healthcare magazine ranked Pullman Regional Hospital 17th among its 100 Best Places to Work in Healthcare across the country. For eight consecutive quarters, nationwide, the hospital has ranked in the top 3 percent in patient satisfaction and No. 1 in the state of Washington in patient satisfaction.

In 2007, Press Ganey reported that both physicians and staffs overall satisfaction with the hospital were above the 90th percentile. In 2008, the Washington State Hospital Association named Pullman the top-performing hospital for hand hygiene efforts.

He has impeccable integrity. People trust him, says Jeannie Eylar, the hospitals director of nursing. Because of that sincere trust, and because he believes in the capabilities of the people who work here and live here, Scott has been able to accomplish some amazing things with our community, our board and our medical staff.

People really do feel that they can have choices over their own work environment, she adds. Scott really emphasizes high-level responsibility and choice. He has helped us make many fundamental changes, with a lot of amazing [results].

Outstanding Health Care Volunteer

Ronald McKay, Vice President, Global Credit Union

Four years ago, Spokanes Empire Health Services was in trouble.

Its two hospitals, Deaconess Medical Center and Valley Medical Center, were getting clubbed in a very competitive market, and the system reported a loss of $34 million. Its board of directors recruited four new members, among them a credit union vice president named Ronald McKay. At their first board meeting, Empires CEO resigned. Soon afterward, the boards own chairman left as well. Empires ship appeared to be sinking fast.

All of us knew the new chairman of the board had to be Ron, explained Judy Cole, whod joined the board along with McKay. He has such a long history of giving back to the community, a long history of service.

Maybe so. But what he undertook was far beyond ordinary service. Along with his job at the credit union, Ron basically spent the last year working full time for Empirewithout salary, Cole says. Ron oversaw the largest business deal, in terms of dollars, in Spokanes history.

In essence, McKay led Empires board through the process of studying the organizations options. It soon became clear that Empires best chance for survival lay in offering itself for sale to a larger health care player with enough capital to keep the business afloat. After studying numerous offers, the best option seemed also the trickiest and most controversial. The Spokane not-for-profit system, whose roots go back more than 100 years in the Spokane area, would be sold to a Tennessee-based, for-profit enterprise, Community Health Systems.

The metamorphosis from nonprofit to for-profit entity required submission of 8,000 pages of documents to the state, a process that took eight months. When the deal was completed, McKay had to sign 1,000 separate documents. Despite protests from some in the community, as well as some Empire staff, the sale went through on Oct. 1, 2008.

The result? Within a month, the organization was reinvigorated with an infusion of $100 million. Over the next five years, Empire will get 300 new inpatient beds, 46 critical-care beds, 40 new labor and delivery beds, 10 state-of-the-art infant incubators, and a mountain of other equipment and supplies. In addition, because Empire had been a nonprofit organization for more than a century and had built up some $80 million in equity from its tax-exempt status, state law required this equity to be turned into a new nonprofit called Empire Health Services Foundation. It now will provide health care and fitness programs to the underserved in the community.

Mike Taylor, director of engineering services for the city of Spokane, who also served on the board, lauds Global Credit Union, because it basically provided Empire a loaned executive for two full years.

But Taylors highest praise is reserved for McKay and the work he accomplished. Ron set aside two years of his career to get this done. His leadership was outstanding, says Taylor. [Empire] simply never would have succeeded without him.

Employer Achievement in Health Care

Ron Sims, King County Executive

King County Executive Ron Sims has long been known as one of the regions strongest politicians. But hes also considered one of the few elected officials who has a firm grasp of the health-care crisis.

When it comes to understanding heath-care issues, Ron Sims isnt like most politicians, says one member of our panel of judges. Hes really become a student of health care and put his learning to work.

Sims led King County in developing a two-pronged approach to curbing health-care costs: 1) improve quality, and 2) reduce employee demand for health care by investing in their health.
King Countys innovative approach has drawn interest from across the country, and now the county has posted an online tool kit to help both public and private organizations follow its lead.

The benefit plan offers lower out-of-pocket expenses to employees that choose to take a risk-assessment evaluation that identifies behaviors that put them at risk for deteriorating health. After the assessment, employees may participate in a voluntary individualized action plan that helps them lower their risks. More than 90 percent of eligible King County employees, their spouses or domestic partners participate.

Sims leads county employees by example: He became an avid cyclist, maintaining a fitness program and losing 50 poundsand hes kept it off. For several years in a row, he completed the 200-mile Group Health Seattle-to-Portland Bicycle Classic.

Now, Sims mission is to extend the countys health insurance ideas beyond his own employees to regional businesses and citizens. He was the driving force behind creating the Puget Sound Health Alliance and also served as its boards first CEO. Through the alliance, he convened some 150 organizations representing more than 1.5 million insured.

Runner-up

• K. Bruce Straughan, president, isomedia Inc.

Outstanding Community Outreach

Harborview Medical Center

When it comes to community outreach in the medical profession, the 19 organizations and individuals nominated in this category were all certainly worthy.

But Harborview Medical Center ended up racing away with this award, becoming the unanimous choice of the judges.

Its easy to see why. In fiscal year 2007, Harborview provided $124 million in charity care, more than 20 percent of all charity care in Washington state. Much of these funds helped the institutionfounded as the county welfare hospital in 1877meet its mission of serving the poor, the homeless, new immigrants, refugees, the uninsured and the underserved.

Often that role has meant taking its services off Seattles Pill Hill to wherever its clientele lives, whether low-income neighborhoods, immigrant communities or homeless shelters. Each year, Harborview provides more than 8,300 medical visits to the homeless and low-income community living in downtown Seattle at its Pioneer Square Clinic.

Other Harborview outreach programs connect homeless and recently housed clients with primary care by providing immediate access in places where they receive other services, such as shelters, the YWCA and a center run by the Salvation Army.

I think Harborview gets more recognition on a national level than it receives locally, says Greg Vigdor, president and CEO of the Washington Health Foundation (a runner-up in this category). Harborview does so many really important things to help create our community safety net. Part of what really makes things work around here is the deep commitment Harborview has made to make sure that everyone gets care.

During the past five years, Vigdor points out, as tighter money and stricter insurance reimbursement policies have put more stress on the health-care system, Harborview has focused on getting other area hospitals and specialist physicians to recognize their community responsibilitiesand accept more patients who cannot pay or have no insurance.

Harborviews services also include outpatient mental health programs, and its staff works to navigate language and cultural barriers. For example, at its International Medicine Clinic, Harvorview provides interpreter services in more than 80 languages and dialects. A program called Community House Calls incorporates specially trained bilingual and bicultural caseworkers into Harborview health care teams; outreach includes home visits that improve understanding of patients living conditions and family support systems.

Harborview works with King Countys outreach program aimed at preventing and controlling chronic diseases such as diabetes, asthma and obesity in low-income areas of Seattle and South King County.

Having a bed to put somebody in is not the same as having a bed and a specialist there to provide care when people need it, Vigdor adds. Sure, Harborview helps people who need care connect with community clinics, and they also admit them to Harborview when its necessary. But beyond that, they get the rest of the medical community to do more than they normally would, and that makes the communitys overall safety net even better.

Runners-up

• Columbia Basin Health Association
• Washington Health Foundation