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FALL 2008

Recognizing The Importance Of Narrative Healthcare

Summa Physicians Inc.Why It Works

Innovative Healing: Humanitarian Use Devices

t r a n s f o r m a t i o n

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summamagazinecontents

The future of healthcare is right around the corner –

and so is Summa Health System. We know that

the future of healthcare depends on innovations

in technology and the spirit of collaboration.

Summa is here to deliver the future of healthcare

to the people of Summit County – and beyond.

C R Y S TA L C L I N I C O R T H O PA E D I C C E N T E R

T H E J E A N B . A N D M I LT O N N . C O O P E R C A N C E R C E N T E R

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The Future Of Healthcare… Is Around The Corner.

T O L E A R N M O R E V I S I T S U M M A H E A LT H . O R G

SUMMA MAGAZINEPublication of the Summa FoundationAll rights reserved, ®2008

Thomas J. StraussPresident & CEOSumma Health System

August A. Napoli, Jr.President & COO Summa Foundation

Ann Amer BrennanBoard Chair Summa Foundation

Jill Y. StefancinDirector of CommunicationsSumma Foundation

Design and Layout

TRIAD Communications, Inc.

Summa Foundation Magazine is a publication of Summa Health System. Copyright © 2008 Summa Health System. All rights reserved. Reproduction or use without written permission of written or pictorial content in any manner is prohibited. Printed in the United States. Periodicals postage paid at Akron, Ohio. The magazine accepts no unsolicited manuscripts, photography or artwork. Send change of address to Summa Foundation, 525 E. Market Street, Akron, Ohio 44304.

If you wish to be removed from this mailing list, write to us at Summa Foundation, 525 E. Market Street, Akron, Ohio 44304. This publication is for informational purposes only and should not be relied upon as medical advice.

Summa Foundation

525 East Market StreetAkron, Ohio 44304330-375-3159 voice330-375-3012 fax

thesummafoundation.orgA Day In The Life 29

The Picture of TransformationThis examination of Summa’s impact on the health of its patients in Northeast Ohio reveals that they’re out to improve more than just health – but also the way healthcare works nationwide.

coverstory

SPI – Why It Works 20

Medical Technology 8

Government Relations 32

12features

inthisissue

volume 1 issue 1 fall 2008

The Residency Research Legacy How does medical research relate to training new physicians? We examine the role of research at Summa – the bridge that connects postgraduate medical education and medical breakthroughs.

24Narrative Health Care Summa’s top scholars share their thoughts on the vital necessity of understanding not only a patient and their illness, but the stories that relate to them.

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summamagazinecontents

SUMMA MAGAZINEPublication of the Summa FoundationAll rights reserved, ®2008

Thomas J. StraussPresident & CEOSumma Health System

August A. Napoli, Jr.President & COO Summa Foundation

Ann Amer BrennanBoard Chair Summa Foundation

Jill Y. StefancinDirector of CommunicationsSumma Foundation

Design and Layout

TRIAD Communications, Inc.

Summa Foundation Magazine is a publication of Summa Health System. Copyright © 2008 Summa Health System. All rights reserved. Reproduction or use without written permission of written or pictorial content in any manner is prohibited. Printed in the United States. Periodicals postage paid at Akron, Ohio. The magazine accepts no unsolicited manuscripts, photography or artwork. Send change of address to Summa Foundation, 525 E. Market Street, Akron, Ohio 44304.

If you wish to be removed from this mailing list, write to us at Summa Foundation, 525 E. Market Street, Akron, Ohio 44304. This publication is for informational purposes only and should not be relied upon as medical advice.

Summa Foundation

525 East Market StreetAkron, Ohio 44304330-375-3159 voice330-375-3012 fax

thesummafoundation.org A Day In The Life 29

The Picture of TransformationThis examination of Summa’s impact on the health of its patients in Northeast Ohio reveals that they’re out to improve more than just health – but also the way healthcare works nationwide.

coverstory

SPI – Why It Works 20

Medical Technology 8

Government Relations 32

12features

inthisissue

volume 1 issue 1 fall 2008

The Residency Research Legacy How does medical research relate to training new physicians? We examine the role of research at Summa – the bridge that connects postgraduate medical education and medical breakthroughs.

24Narrative Health Care Summa’s top scholars share their thoughts on the vital necessity of understanding not only a patient and their illness, but the stories that relate to them.

5

25%

Cert no. SW-COC-002224

4 5 thesummafoundation.org

“I think the narrative medicine movement is a way of heightening awareness among medical educators of the need to continue to emphasize that while much of medicine is scientific and technologic, it is, in its very essence, a human, and therefore a narrative enterprise.”

– Joseph Zarconi, M.D.

“Traditional health professional training is focusing more and more on the science and technology aspects of medicine in preparing the next generation of the healthcare workforce,” said Dr. Joseph Zarconi, vice president of medical education at Summa Health System, in a recent interview. “What has been marginalized in that training, in my opinion, are the humanistic and professional dimensions of care giving.”

That concern led Zarconi, along with colleagues Sally Missimi, Ph.D., Lura Pethtel, M.Ed., and John Engel, Ph.D., to author Narrative in Health Care: Healing Patients, Practitioners, Profession and Community, a newly published book that discusses the need to advance the discipline of narrative medical practice in care giving as well as in caregiver education.

Narrative medicine is defined as healthcare practiced by nurses and physicians who possess the narrative competence to recognize, absorb, interpret, and be moved by stories of illness, selfhood, and communion with colleagues, profession, and community.

“I think the narrative medicine movement is a way of heightening awareness among medical educators of the need to continue to emphasize that while much of medicine is scientific and technologic, it is, in its very essence, a human, and therefore a narrative enterprise,” continued Zarconi. “I wouldn’t necessarily say that the medical field has moved away from this type of training, as much as I would say that it has moved toward greater emphasis on the biomedical aspects of medical care at the expense of equal time for the humanistic aspects of care.”

Before collaborating on the book, the group previously worked together to establish Summa’s Institute for Professionalism Inquiry (IPI) in 2004. The IPI provides a year-long narrative medicine curriculum for the family medicine residents and plans to include other residency programs in the near future. They developed a semiannual conference series, Humanism and the Healing Arts, to focus on the mission of the IPI, which is to explore the complex relationship between acts of professionalism and humanism as it relates to the care of patients.

Another essential part of Summa’s efforts to sustain this sort of caring culture in medical education and the clinical environment is the recruiting, nurturing and retaining of humanistic and professional role models as faculty members for all of the residency programs.

In addition to Summa, there are other organizations and individuals across the country to which these principles are central to medical education and medical care. In particular, the authors would like to acknowledge Dr. Anthony Kuzel at the Virginia Commonwealth University, Dr. Rich Frankel at the University of Indiana School of Medicine, and Dr. Rita Charon at Columbia University, all of whom were collaborators in the development of this book.

All proceeds from the sale of Narrative in Health Care: Healing Patients, Practitioners, Profession and Community will benefit the Summa Foundation’s support of the Institute for Professionalism Inquiry.

An Account of Self: Recognizing the Importance of Narrative Healthcare

Joseph Zarconi, M.D.

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Dear Friend:

On behalf of everyone at the Summa Health System, it is my pleasure to welcome you to our inaugural issue of the Summa Foundation Magazine.

When Akron City Hospital first opened its doors 116 years ago, townspeople of even the slightest means were encouraged to support it – and they responded in some pretty heartwarming ways.

Paige Bros. & Co. sent a lawn mower. The office staff of Buckeye Reaper Works donated a cow to provide milk for patients. Presumably to make surgery go a bit smoother in those days before anesthesia, one person even delivered a gallon of whiskey.

While the community invested in us, it was only natural that we would invest in them. That is the covenant we have shared with our community for more than a century. As we have grown across the five-county region – becoming a presence in Portage, Medina, Stark, Summit, and Wayne Counties – that covenant has continued to guide us.

Most recently, it has helped see us through a whirlwind few years of change that has transformed Summa into a leading healthcare option in Northeast Ohio. From that one hospital, we have grown into a system of six hospitals, a health plan, a physician hospital organization, outpatient health centers, a multi-specialty physician organization, and a joint venture organization with key physicians.

Today, Summa—in addition to being the largest employer in the region, directly and indirectly supporting nearly 18,000 full-time jobs and generating $1.6 billion of economic activity—has three other distinctions: quality, safety and value. It is well-documented that our quality and safety is better than any other health system in the region, yet our value is such that we can deliver our quality at about two-thirds the cost of other health systems in the region.

Summa is also the largest safety net provider in the five-county region, providing more than $31 million in net uncompensated care in 2007 and investing more than $13 million of subsidized health services directly into the community. Because Summa is a locally based, nonprofit organization, the decisions that affect you and your family are made by people who reside here, and who know the community and the healthcare needs of its residents.

At the heart of all this has been the transformation of the Summa Foundation itself. Under the leadership of President August Napoli, the Foundation is taking a greater leadership role: raising Summa’s profile with thought leaders, building the Summa brand both regionally and nationally and guiding Summa’s work with local leaders to create a plan for the BioInnovation Institute in Akron.

We all feel blessed to lead this system at a time when our ability to do good for the people of this community is greater than it has ever been. We look forward to honoring our covenant for the next generation and beyond.

Thomas J. Strauss President & CEO Summa Health System

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EXCERPT FRoM a Narrative iN HealtH Care, Chapter 6, pp.171–175

When a person is struck by serious physical or psychological illness, the fear and anguish that often arise can be overwhelming. Will I die? How can I complete my work? What will become of my loved ones? Why is God punishing me? All of these are issues of the spirit. All reflect the felt discontinuities in the person’s narrative identity – disruption in the coherence of the person’s life story – concepts which we explored in Chapter 2 through the work of Brody, Carr, Linde, Rimmon-Kenan, and others. Narrative is the doorway to the spirit. Attending to the existential concerns of the patient will most likely result in a rich narrative exchange.

Compassionate Presence

One of the greatest gifts in a time of illness is to be attended by a practitioner who is technically competent, caring, and compassionate – one who can work to illuminate the meaning of the illness experience and help the patient to gain a renewed sense of hope for the return of wholeness and life continuity. Unfortunately, in today’s fast-paced health care environment the patient may not always find such an individual. All too often patients meet caregivers who seem too harried to be totally present for them, and who appear unable or unwilling to engage in their stories. Patients may resent the lack of interconnection and may even begin to doubt the practitioner’s competence. At other times, although the clinician appears to be present and caring, her lack of authenticity is immediately clear. It is quickly perceived that she is not really hearing or responding appropriately. On this matter Connelly writes:

In medical encounters as in social encounters, one person may feel abandoned or neglected when the other is not paying attention… Patients may choose not to disclose symptoms or significant life events in the absence of confidence, support, and trust… Being in the present moment involves time and awareness. Time is the present; it is now. It is not the future of the unknowable next moment; it is not the past with memories beginning to vanish. It is now. Awareness is conscious and personal; it is wakefulness and mindfulness of the happening of the moment; it involves thoughts, ideas, images, emotions, sensations, and movements.

The act of being mindfully present for a suffering patient is the tender core of the following story:

My friend suffers from chronic polymyositis and rheumatoid arthritis, each in its own right a severely debilitating disease. Surgery performed on her crooked and misshapen fingers has improved her hand capabilities somewhat, but the severe weakness of her muscles, along with the deformities of her feet, cause her to creep along slowly in baby steps, and even sitting can be torturous. Recently I drove her to the rheumatologist’s office. When she emerged from the office and we returned to the car she was all smiles and exclaimed, “Dr. Max is so wonderful. I am so blessed to have found both him and my sweetheart orthopaedic guy.”

“That’s quite a testimonial,” I said. “Why are you so blessed? What’s so great about them?” I asked.

“Every time I go to see Dr. Max,” she replied, “he sits right down in front of me and looks right into my eyes and asks me how I’m doing, and

then explains what he thinks is going on and suggests what might help if I am willing. He always asks me if I understand, and he answers all my questions. Today, when I stood up to leave, he saw me inching along the wall for balance and he put his arm around my waist and took my hand and walked with me out to the lobby. Isn’t he something? And you know, Dr. Jake, my orthopaedic surgeon, is just the same way. They’re both so different from that first bozo doctor I had – he always made me feel like just another nobody. He was always in a hurry, he never sat down with me and he never listened to me. He just always told me what he was going to do about this and that, he wrote in his chart and then left the room.

“Yes, I am truly blessed. Today I told Dr. Max that I know I won’t live very much longer and I wanted to thank him for all he has done for me and for being so kind and caring through all this. Tears came into his eyes – and mine, too.” ~LLP

Presence is paradoxical. It is part of being human, yet it is a skilled activity that must be consciously practiced. When mastered, it is an exceedingly effective way of relating to a patient’s experience. As Connelly notes above, presence means being with the other person in this moment – physically, emotionally, and spiritually. It means being aware of one’s own concerns, beliefs, and moral standards, yet not allowing them to confuse what’s going on in the moment. It means being respectful of what the other is relating, and bearing empathic witness to her suffering, her fear, or her joy. Presence means connecting with the spirit of the other person and responding supportively – perhaps with a gesture or just with attentive silence. Presence is the grounding

Practicing Compassionate Presence And Mindful Listening

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process of all the important elements of compassion and healing; it is the cornerstone of the therapeutic relationship. Presence is palpable. And perhaps it is most obvious when it is absent.

There is a channel between voice and presence, a way where information flows. In disciplined silence the channel opens, with wandering talk, it closes. ~Rumi

According to Rinpoche, a Tibetan Lama, and Shlim, an American physician, being mindfully present in the medical encounter demonstrates caring for the patient, and this kind of attentiveness results in fewer errors in medical judgment and inspires patients’ confidence in the caregiver. Thus the mindful and compassionate practitioner functions more effectively and intelligently. Speaking about the importance of mindfulness, Ronald Epstein, a family physician, writes: “The goals of mindful practice are to become more aware of one’s own mental processes, listen more attentively, become flexible, recognize bias and judgment, and thereby act with principles and compassion.” Launer sees the mindful caregiver as an “observer-participant” who is able to co-construct a new story with the patient while at the same time observing and tracking its progress. This is a complex task that is explained in the following way by two spiritual leaders, Ram Das and Gorman:

The consciousness we have access to is greater than the particular thoughts we’re having or skills we’ve mastered. We have all these. But we have perspectives as well – all within our spacious awareness. What’s critical is that this awareness allows us to hear,

along with everything else, whatever it is. The quiet mind makes possible an overall awareness of the total situation, including ourselves.

To better envision the mindful and compassionate practitioner, it is useful to consider how caregivers function with the number and variety of patients whom they meet daily. Patients who listen closely to the counsel we offer and who respond appropriately, and who are cooperative and compliant, are easy to work with. These are the ideal patients, and we feel good about caring for them. But what about the very different and difficult patients – those who are unhappy, ungrateful, irritable, abusive, and who never seem to change regardless of how much time we spend with them? How do we react to them? And then there is the patient who is weak, ineffective, and whiny – a “victim personality.” In each situation, we must remember that here is an individual who is suffering spiritually, one who deserves our mindful and compassionate presence. How do we stay connected with her? How do we respond? Levinson describes a method that she terms mining for gold which she uses to change her feelings about a difficult patient. She learns something new about the patient (children, hobbies, common interests, etc.) and continues this focus throughout subsequent visits. Over time she reports that the relationship changes dramatically. The patient is more satisfied, makes fewer visits, accepts treatment more readily, and is more compliant.

Rinpoche and Shlim remind us that dealing with a difficult patient is a special opportunity to display compassion and empathy. But how do we do this when we ourselves are

provoked to anger and resentment by their behavior? It is precisely in these moments when we must stop, take a few deep breaths, and pull hard on our own spiritual bootstraps, knowing that without adequate tolerance and patience we cannot possibly be compassionate and empathic. Is it always possible to exercise such restraint? In order to prevent our own emotional upheaval and burnout we must be wise in setting limits and boundaries to the extent of our tolerance, and step back and re-establish equilibrium. We must learn to practice altruism conditioned by phronesis as discussed in Chapter 4.

John D. Engel, Ph.D., Joseph Zarconi, M.D., Lura L. Pethtel, M.Ed., and Sally A. Missimi, Ph.D. Narrative in Health Care: Healing Patients, Practitioners, Profession and Community. Oxford: Radcliffe, 2008. Jill Y. Stefancin

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Humanitarian Use Devices

INNOVATIVE HEALING:

Providing Options for Doctors and Relief for Patients

What if a cardiologist realizes he can use an existing device in a new way to solve an unusual

case? Can a diabetic find relief for gastroparesis through a device that uses mild electric

pulses to stimulate the stomach? What happens if a broken bone is so damaged that

traditional surgical methods aren’t working to help it mend? Each patient is unique, and while

traditional medical practices help most recover, sometimes doctors must use extraordinary

methods to heal their patients. For one patient at Summa’s St. Thomas Hospital, it meant

treating a stubborn fracture with a Humanitarian Use Device (HUD).

The patient, a 46-year-old female, suffered multiple traumatic injuries in a motor vehicle accident in 2002, including having her left foot crushed.

Foot and ankle injuries can be some of the most painful in terms of healing. The process can be quite lengthy because the ankle and foot bear the weight of the patient, and the foot must also remain flexible so it can rotate for mobility.

Her orthopaedic surgeon at Summa knew that it would be a long healing process. One of the first surgeries to repair her ankle was an athrodesis – a surgery that essentially cleans out the joint and encourages bone and fracture healing by utilizing a commercial bone graft material along with medical hardware, such as a plate and screws.

While this type of surgery is successful for many patients, the screws that hold the plate in place can be quite painful because of the physical force and weight on the ankle and foot. Her doctor performed more surgeries to try and relieve the crippling pressure on the patient’s foot, while still providing enough support for the injured bone. During subsequent surgeries, Dr. Alexander grafted some of the patient’s own bone from her tibia and pelvic bones in an effort to promote healing.

With the fracture still not properly healing, her doctor decided to explore the use of a HUD. He suggested using a biological compound used to stimulate bone growth. It is a powder that is reconstituted with saline during surgery to become putty-like in texture; which is then permanently placed directly in the fractured bone to encourage bone growth.

A Humanitarian Use

Device (HUD) is a

device (biological or

physical) that benefits

patients in the diagnosis

or treatment of an

uncommon medical

condition or disease,

affecting fewer than

4,000 patients a year

in the United States.

These devices, usually

created by biomedical

engineering firms and

manufacturers, must be

approved by the Food

and Drug Administration.

HUD

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Because HUDs are created to treat rare medical occurrences, the FDA grants special exemptions from some requirements. Their use is so limited, studies needed for approval would be impossible to carry out. However, even though these devices are not commonly used, they may be recognized as standard or even preferred devices for certain circumstances, regardless of their potential risks.

Some of the risks associated with the use of the HUD included the possibility of an allergic reaction to the material, an immune reaction resulting in the development of antibodies against the protein material, infection, hardware complications, and more. After reviewing the risks and benefits of the HUD with her doctor, the patient decided to undergo the surgery to try to heal the bones and relieve her agonizing pain.

HUDs are usually created or invented by researchers at biomedical engineering companies or physicians and researchers. The manufacturer of the HUD then applies to the FDA for a Humanitarian Device Exemption. Once granted this status, the manufacturer can market the HUD. Physicians and surgeons learn about various HUDs through research and from representatives from the medical device manufacturers.

Other general criteria for HUDs include:

• Nocomparabledevicealready available

• Noexposureto“unreasonable or significant risk of illness or injury”

• Potentialbenefitsofthe device outweigh its risks

In addition, HUDs are subject to strict review by a hospital’s Institutional Review Board (IRB). Summa’s IRB meets once every month and is made up of 17 members, including physicians, surgeons, nurses, a pharmacist, an attorney and several community leaders.

The FDA also allows HUDs to be used in emergency cases and for compassionate use as long as certain criteria are met regarding consent, authorization and follow-up reports.

This particular HUD is a biological compound used to stimulate bone growth. It is a powder that is reconstituted with saline during surgery to become putty-like in texture; then it is permanently placed directly in the fractured bone to encourage bone growth.

While most fractures heal through traditional surgical methods, the orthopaedic specialists at Summa Health System also rely on innovative research, technology and treatment to significantly impact and make every effort to improve a patient’s quality of life.

Today, after the HUD surgery in September 2007, the patient is finally free from her debilitating constant pain. She plays golf and rides her horse – activities that at one point, she thought she may never be able to do again. “My doctor and Summa are the ultimate. We’ve been through so much together that he’s more than just my surgeon – he’s my friend,” she says. “And I don’t think you can get better care anywhere than at Summa.” Jill Y. Stefancin


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SnapshotsofExpansion

There are times when it is only by looking at photographs it becomes clear how much a child has grown, how much a family has changed or how much the world has shifted.

So consider the following “snapshots” and what they say about an evolving institution, an expanding mission and new avenues of opportunity.

SNAPSHOT ONE:A member of Congress stands before the Summa community, making a commitment to support Summa’s efforts to make Akron and Northeast Ohio a national hub for healthcare in the 21st century.

SNAPSHOT TWO:Two of Summa’s leading physicians, sitting around not an examination table in Akron, but a conference table in Washington D.C., sharing the outcomes of their research with the people who will be advising the next president of the United States on healthcare reform.

SNAPSHOT THREE:A group of Summa executives and other Akron-area leaders gathered before one of the largest foundations in the country, proposing grant funding to help create a biomedical corridor that will add new vibrancy and economic opportunity to downtown Akron.

These three snapshots all have something in common. Summa Foundation worked to “develop” each of them.

“We make a living by what we make. We make a life by what we give.” –Winston Churchill


the picture of

Where manufacturing

was once the

bedrock of Akron’s

local economy, today

it is healthcare.

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The Changing Face of Philanthropy

In part, those changes are reflective of changes in philanthropy itself.

Until recently, the word philanthropy seemed essentially synonymous with the word fundraising. However, by the literal definition of the word – love of humankind – fundraising is just one of many tools that allows individuals and institutions to act on their philanthropic spirit.

As August Napoli Jr., president and COO of Summa

Foundation says, “We are on the edge of a whole new era in philanthropy: an era in which the ways people care, how they show they care, and how they get involved is radically changing.”

While giving was once almost exclusively the province of people who were older, more established, and often far removed from the challenges their donations addressed, many of today’s philanthropists seek to be more engaged with the causes they support, often giving not only money, but also time, guidance and strategic support.

Certainly, these weren’t the undertakings that Dr. Walter A.

Hoyt envisioned back in 1976 when he arranged a gift of $5 million from Akron City Hospital to support and

perpetuate medical education and research – a gift that

became Summa Foundation.

Summa Foundation remains proud of its efforts to advance

Dr. Hoyt’s initial vision. Summa’s 13 residency programs at

Akron City and St. Thomas hospitals, which have educated

some of the most dedicated and accomplished physicians

serving patients today, continue to be the crown jewel and

one of the most lasting testaments to the Foundation’s

work. So do the investments the Foundation has made in

orthopaedic, cardiovascular, cancer, behavioral health and

surgical research that have propelled Summa into a position

of national leadership in each of these areas. Providing the

community millions of dollars of annual uncompensated

care – last year’s total was $31 million – is a part of

Summa’s original mission that the Foundation is proud to

fulfill. Those commitments remain at the core of the

Foundation’s work.

However, just as the original gift of $5 million has grown to

nearly $100 million today, so too has the range of projects

undertaken by Summa Foundation.

“Five years ago… the bulk of the energy of the Foundation was spent on stewarding the funds that had come in,” says Ann Amer Brennan, chair of the Summa Foundation board

of directors. “Now the responsibilities of the Foundation are much broader, involving the areas of community relations and diversity, government relations, and medical education and research. We have a very full plate.”

“By broadening the definition of the Foundation and involving all of our constituencies – government entities, individual philanthropists, grateful patients, companies and foundations – we’re now representative of all who have a stake in the fulfillment of our mission to help build and sustain a healthier community,” said Napoli. “We have a responsibility to appreciate the diversity of the community around us, the diversity of our fellow staff members and the diversity of resources in the five counties that we serve.”

That change in thinking on the part of today’s philanthropists requires a change in thinking on the part of today’s philanthropies. Summa Foundation recognizes that it is not enough to simply solicit and accept gifts. It’s now necessary to work collaboratively with donors and potential donors in seeking out opportunities for giving that are really opportunities to not only create, but implement lasting change.

Unfortunately, there is no shortage of opportunities. America’s brand of market capitalism – combined with the limits of government action – has left many significant problems unresolved and many challenges unaddressed, from environmental protection to healthcare to education. Today’s philanthropists and philanthropies certainly hope government will be a partner in closing those gaps, but aren’t content to simply wait for them to be closed. There needs to be something new.

That has been Summa Foundation’s experience.


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Not a Community Foundation, but a Foundation that is Anchored in Community

When most people think of Akron, Ohio, they think of rubber and tires.

That certainly makes sense. Historians say that when Akron leaders came together in the 1870s to pitch the city as a great place to start a business, one of the first to take them up on the offer was B.F. Goodrich, who saw the city as a great place to build the first rubber factory west of Appalachia. For the next century, the city grew on the strength of the manufacturing sector. More companies followed, as did more developments – from synthetic rubber to vinyl – and more uses, from bullet proof gas tanks on military vehicles in WWII to mass produced dolls for children.

By the mid 1990s, however, only the vestiges of that industrial empire remained, with the foreign purchase and departure of all but one of Akron’s big four rubber companies.

The story would have a tragic ending if indeed it ended there, but from that emptiness emerged an opportunity to position Northeast Ohio as one of the premiere healthcare destinations in the United States. And Summa Foundation has undergone its own transformation in order to help Akron be a leader in this transformation.

Since 2001, healthcare alone has been responsible for private sector job growth. In the last six years, the healthcare industry has added 1.7 million jobs while the rest of the private sector as a whole has added none.

For all of the promise healthcare offers, medical institutions in Akron have recognized that competition with one another is not the answer – because even a victory yields only a slightly larger piece of a shrinking pie.

Similarly, when Dr. Deepak Edward, Chair of the Department of Ophthalmology, transitioned from the University of Illinois in Chicago to Summa in 2007, a state-of-the-art ophthalmology research laboratory was needed to support his research interests. The Summa Foundation helped to provide it. Both a clinician and a researcher, Dr. Edward is leading innovation in ophthalmology research that will significantly improve patient care. In that effort, it is also anticipated that new discoveries will be disclosed in the field that can potentially lead to commercialization opportunities.

Summa Foundation has made these investments because of the belief that not only do the people of Akron deserve the best in care, but that to truly position Northeast Ohio as a national healthcare hub, there needs to be a critical mass of talent that will bring attention and honor to Summa and the region.

One star researcher or one new initiative may not change a city alone, but each new leader or program is one more than Summa and Akron had before, and each builds on the work done by others. These efforts demonstrate that at all levels of impact, a new set of rules govern how we give and help. The Summa Foundation has begun to embrace a catalyst role: building relationships and bringing sides together to effect positive change.

A dedicated commitment to the communitythatexiststoday…

Change, to Summa Foundation, means two things.

The first is the day-to-day ways we can impact the life of the community of today. The second meaning of change is working to envision a different, better future.

The solution is to work together to create a national healthcare hub.

Akron has the tools and talent that are a prerequisite for this vision: three major healthcare systems, the Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Kent State University, The University of Akron, the technology and polymer industries and the liquid crystal industry.

The ingredients for tomorrow’s success are already in place.

That success, though, will require several things.

Retaining and Recruiting

First, it will require not just training young talent (part of the Foundation’s original mission), but also retaining it. In the height of the rubber days, the joke was that the “three R’s” in a West Virginia education were reading, writing, and Route 21 – the road that led to Akron for the jobs that could be found there.

Before Akron can again be a job magnet, it must keep the talent it has developed. This is an area where Summa Foundation has embraced a role broader than its original mission. When it comes to recruiting, Summa Foundation is recognizing that just as talented people are needed to practice medicine, talented people are also needed to advance it.

After completing his residency at Summa, Dr. Demond Scott, a sought-after primary care physician, could have chosen to establish his practice anywhere. With a focus on chronic disease management of underserved populations, his talents and interests are clearly needed in many communities. With the help of Summa Foundation, Dr. Scott is now beginning to develop a Center for Minority Health and Health Disparities Solutions that will not only provide primary care services, but will work to identify public health solutions through research, education and area partnerships with other public health organizations. Summa Foundation was able to help fund this vocation and keep his talent in Akron.

When it comes to impacting the life of the community today, Summa Foundation is finding innovative ways to bring Akron residents into the continuum of care – ensuring a strong contribution to a healthier community.

A rapidly increasing number of vacancies in the area’s allied health fields reflect national statistics and could reach a crisis level in the near future. With more than 80 million baby boomers beginning to retire over the next 20 years and longer life expectancies, the demand for highly trained healthcare workers will increase exponentially.

To address this need, Summa has partnered with five other regional healthcare systems to create the Northeast Ohio Health, Science and Innovation Coalition (NOHSIC), a unique, employer-based coalition that is proactively working to train, recruit and reshape the existing healthcare workforce to fill current and future vacancies.

“NOHSIC was founded on the principles of innovation and collaboration,” said Napoli. “Through active participation, Summa is leading the creation of a pipeline of skilled workers through its partnerships with NEOUCOM and other organizations. We are helping to develop and maintain talent right in our own backyard and we will continue to participate in initiatives that provide great benefit to the development of our great region.”


the picture of


summamagazine

…Whilebuildingastrongercommunitytomorrow: A regional health collaborative and a biomedical corridor

As Summa Foundation works to strengthen the Akron of today, it also has one eye keenly focused on the horizon, helping Akron to emerge as a national healthcare hub.

Where manufacturing was once the bedrock of Akron’s local economy, today it is healthcare. Not only has Summa been ranked one of the top hospitals in America for the last 11 years by U.S. News & World Report, but it is also the largest employer in the five-county region, directly and indirectly responsible for nearly 18,000 jobs.

As manufacturing companies continue to disappear and jobs go overseas, healthcare will continue to be the biggest engine for jobs and growth in Northeast Ohio for years to come. Unlike manufacturing jobs, local hospitals are not going to move to India or Mexico.

HISTORY OF THE SUMMA FOUNDATION

If healthcare isn’t just about tests and treatments, but jobs and economic growth, then Akron is poised to take advantage and Summa Foundation is eager to advance that effort.

Summa Health System and Summa Foundation are part of the recently announced BioInnovation Institute, created in collaboration with area hospitals and universities to leverage individual strengths and position Akron as a global leader in biomedical research, education, clinical services and commercialization.

The BioInnovation Institute will help to establish a true biomedical corridor, in which today’s advances in polymers could lead to tomorrow’s advances in orthopaedics – and where the institutions of medical learning and practice that are already in Akron combine their efforts to create a whole that is greater than the sum of their individual successes, a truly new and renewed Akron.

The evolution of the Foundation and its significant impact on the region’s economic development goes far beyond Walter Hoyt’s original vision more than 30 years ago.

coverstory

The Foundation remains true to its mission, while strong community leadership and long-term strategic goals will help it to position Akron as a national destination for innovation in biomedical science and research.

Conclusion – snapshots from the future

So what will the snapshots of Summa Foundation’s work look like 30 years from now?

There will still be snapshots of young physicians whose residencies Summa Foundation supported. There will still be snapshots of area residents whose charity care Summa Foundation made possible. And there will still be snapshots of Summa accepting awards and honors as a leader in several medical fields.

But perhaps there will also be a different picture, a series of them, in fact. The first is of a retiree from Akron who now lives somewhere warm, but has returned to Akron because he needs a hip replacement and wants to go to Summa to get the best, most advanced care.

fundraising and grant review, the Summa Foundation grew and flourished during the 1980s under the guidance of creator Walter A. Hoyt, Jr., M.D., and the leadership of Louis A. Meyers, the Foundation’s first chairman. It was during these inaugural years that the Foundation became more active, securing adequate funding to support physician training and research.

In 1981, the Summa Foundation began its first-ever Annual Giving Campaign, with the objective to increase total assets to assure growth for the future. By 1983, the Foundation had more than doubled its initial $5 million in assets to $12,108,000 and expanded its board from 8 to 24 members. Additionally, several committees were established to

1976 1986 1996 20062008

The Jean B. and Milton N. Cooper

Cancer Center opens in October,

funded by a major gift from

Dr. Milton Cooper in memory of his wife.

The second picture is of the artificial hip itself. It has been designed by a polymer scientist who once would have worked in tire manufacturing, but now works within Akron’s new biomedical corridor.

Summa Foundation sees a picture of that scientist being assisted by materials engineered by students from top-rated educational programs at The University of Akron and Kent State University.

Then there is the procedure itself, performed by physicians trained at NEOUCOM, now working at a state-of-the-art hospital for orthopaedic care.

The final image is a photo taken from a blimp in the sky over Akron, showing a biomedical corridor stretching from the Summa Health System through the center of Akron’s downtown: new businesses doing cutting edge research, manufacturing, and fabrication.

Summa Foundation is working to “develop” these images, too. Between today’s reality and tomorrow’s innovation is an exciting journey of transformation – one upon which Summa Foundation is already making great strides. Jill Y. Stefancin

improve the management of assets and to provide a better vehicle for fundraising and grant review.

What began as a fiduciary for monies received from donations and fundraising, has since evolved into a philanthropic organization that supports the mission of Summa Health System. By integrating fund development, government relations and community relations and diversity, the Summa Foundation creates and implements innovative partnerships, health policy opportunities, and funding strategies to perpetuate the health system’s medical education, clinical research and patient care agenda.

Today, the Foundation holds approximately $100 million in assets (as of December 31, 2007) and is governed by a board of 41 directors. Through contributions and grants, the Foundation invests more than $9 million annually in graduate medical education, research labs, clinical innovations and capital projects, all geared toward the support and advancement of excellent patient care.

The Foundation extends its deepest appreciation to all donors who over the years have given so generously to Summa’s hospitals and have touched the lives of Summa’s patients in the community.

1976 The Summa Foundation was established – then

known as the Akron City Hospital Foundation

– on December 27th to support Summa’s objectives in patient

care, medical education, and research initiatives

through philanthropy.

1977 The Foundation is

awarded status as a 501(c)(3) organization.

1981 The Foundation

began its first ever Annual Giving

Campaign with the objective to

increase total assets to assure

growth for the future.

1983 The Foundation had more than

doubled its initial asset to

$12,108,000 and expanded its

board from 8 to 24 members.

1985Dr. Walter A.

Hoyt, Jr. is appointed executive

director of Akron City Hospital Foundation.

1989 Akron City Hospital Foundation and St.

Thomas Medical Center Foundation merge to form the

Summa Health System Foundation.

1993 Funding from

the Mary S. and David C. Corbin

Foundation establishes

the Vascular Research Lab.

1995 A major gift from

the Mary S. and David C. Corbin

Foundation creates the Corbin

Cardiac Center on the Akron City Hospital Campus.

2001 Harry H. Leuchtag, M.D., a Summa physician who

practiced medicine in the Akron community for 42 years, makes a

substantial bequest to Summa Health

System. His donation is earmarked for the development of the Critical Care Center.

1997 A major gift from Sis and Wright Bronson,

Jr. establishes the Sis and Wright

Bronson, Jr. Center for Renal Care on

the Akron City Hospital Campus.

1998 A gift from the

estate of C. Blake McDowell,

Jr. establishes the McDowell

Trust for Medical Education.

2001The Foundation hosts

the first annual Sapphire Ball, with

proceeds benefiting the development

of the Critical Care Center on the Akron

City Hospital Campus.

2001Funding from

James and Vanita Oelschlager

enables Summa to introduce the

James and Vanita Oelschlager

Chair of Medical Education.

2004With the

announcement of a major gift from Ann and

David Brennan, the Summa Foundation

launches the public capital

campaign to fund the Critical

Care Center.

2006 The Foundation

receives its largest single gift to date from the estate of Florence

Weaver in memory of her husband, Wilfred Weaver.

The coronary care unit at Akron City Hospital

is renamed in their honor.

2007The Vincent and Nancy

DiGirolamo Endowed Chair in Oncology is

established, accepted by Summa Health System Hospitals’

current section head of oncology,

Dr. Douglas Trochelman.

2007The Jim and Vanita

Oelschlager Endowed Chair in Psychiatry

and Behavioral Health is given to Dr. Joseph Varley, current chairman

of the Department of Psychiatry for

Summa Health System Hospitals.

Since its inception in 1976, the Summa Foundation – then known as the Akron City Hospital Foundation – has worked rigorously to support Summa Health System’s objectives in patient care, medical education, and research initiatives through philanthropy. Summa Health System was formed in 1989 when St. Thomas Hospital merged with Akron City Hospital. Today, in addition to the Summa Foundation, Summa Health System encompasses a network of hospitals, community health centers, research, a health plan, a multi-specialty physician organization, a physician-hospital organization, and an entrepreneurial group.

First incorporated to administer several bequest and charitable contributions and provide a better vehicle for

2000A major gift from

Jim and Vanita Oelschlager in 1998 is used to establish the Jim and Vanita

Oelschlager Chair of Medical Education,

accepted by Dr. Joseph Zarconi, vice president of medical education at Summa

Health System.


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20

summaphysiciansinc

Why it Works:

Summa Magazine recently sat down to talk with the

Vice President of Physician Alignment and President

of Summa Physicians, Inc. (SPI), T. Clifford Deveny,

M.D. SPI is an innovative partnership between

area physicians and Summa Health System that

works to ensure patients in Summit, Medina and

Portage counties have access to quality primary and

specialty care, regardless of their ability to pay.

Dr. Deveny is responsible for overseeing all

physician services and alignment activities for

Summa Health System, including employment,

joint ventures and administrative and education

contracts. Previously at Summa Health System,

Dr. Deveny served as vice president of Clinical

Services and Service Lines, chair of the Department

of Obstetrics & Gynecology and medical director

of the Women’s Service Line.

T. Clifford Deveny, M.D.President of Summa Physicians, Inc.

21

SM: Why was Summa Physicians, Inc. (SPI) created?

TCD: SPI was created as a vehicle to capture professional fees for resident clinics in 1987. The concept of the current SPI evolved when Summa had a need to retain and recruit physicians. In December 2005, the Summa Health System board approved the business plan of SPI to help meet the community hospital need. Our first “official” SPI physicians – a surgeon and a psychiatrist – started June 1, 2006. SPI now employs 185 physicians in Medina, Portage and Summit counties in 24 specialty practices. Our doctors go to every hospital and every system, whether or not it is affiliated with Summa.

SM: How does this particular partnership model align with the long-term strategic goals of physicians and Summa Health System?

TCD: SPI provides a sustainable model, one that allows for continued ability to recruit and retain physicians. It was – and still is – an opportunity for growth. When physicians partner with a hospital, it is a much more powerful, attractive thing for the community than having those parties competing. Physicians like having the resources of a big health system, such as financial resources, marketing, things like that.

SM: What’s different about this type of partnership?

TCD: I find that we attract more mission-driven physicians. It’s often difficult for physician practices to survive or to provide care for indigent populations.

Our community is fortunate because many of the SPI physicians devote a large part of their practice to caring for the indigent. With physician/hospital partnerships like SPI, physicians are blind to payment, so a patient’s ability to pay is irrelevant. SPI physicians are paid for the amount of work they do, not on the profitability of the practice. We have physicians in some practices whose patients are all indigent and we try to attract physicians who are interested in providing care for this population. This is also beneficial to patients; before SPI, if you were a self-pay or Medicaid patient, you had limited access points.

SM: How does SPI benefit the patient?

TCD: We are able to provide comprehensive care close to where our patients live, 24 hours a day, seven days a week, regardless of the payer mix. We are here to make sure people are taken care of and our physicians worry about patient care only. Unlike a lot of communities our size, we don’t have any unfilled specialties in our community. We’ve hired 18 behavioral health specialists and psychiatrists. All Summa emergency rooms are covered by specialists.

Hiring everybody and having them be part of a common organization is great, but we’re also creating a culture of integration and community. That’s what we’re working on: enhancing the patient experience.

So from that standpoint, the community is being better served. All specialties are available here in the Akron region, rather than having to travel to larger cities.

thesummafoundation.org

We have found that SPI works as an incentive to keep good doctors in the Akron area. – T. Clifford Deveny, M.D.

Q & A with T. Clifford Deveny, M.D.

23 thesummafoundation.org 23 22

summaphysiciansinc

SM: How does SPI benefit the hospital system?

TCD: Through growth and stability. From a financial standpoint, the hospitals are able to expand services and carry on their mission. One of the things keeping hospital CEOs up at night is worrying if they have enough doctors to treat the patients. When physicians are employed as they are through SPI, you don’t have trouble getting coverage for the ER.

Hospitals also need physicians to operate. A lot of physicians don’t need hospitals; they can stay in an office all day and practice medicine. Hospitals need physician partners to maintain services. SPI keeps physicians in the community to meet the hospital’s needs.

SM: How does it benefit the physicians?

TCD: When a resident comes out of medical school with $200,000 worth of debt and they are a specialist in demand, they can pick and choose where to go. Oftentimes, they won’t choose to stay here; they’ll look for other opportunities. We have found that SPI works as an incentive to keep good doctors in the Akron area.

We take responsibility for all the day-to-day administrative tasks of the practice, so the physicians can focus on practicing medicine.

There are benefits to being part of a system: continuing medical education, research and professional development opportunities, camaraderie and the stability of being part of a system.


The model that we put in place gives people flexibility to find things that work for them. If SPI doesn’t work out for them, there are no penalties; they can go right back to private practice.

When physicians join SPI, they have the option to keep their staff and their offices. We don’t want to change much; we want to take advantage of the efficiencies and the culture private practices have established. They have privileges at Summa Hospitals, but have them at competing hospitals, too. We encourage that.

We try to provide financial and altruistic reasons for them to stay because unfortunately, reimbursements from Medicare, Medicaid and insurance companies here in the Akron area are generally poor. Physicians in this area are paid in the 10th percentile nationally, but work volume is in the 85th percentile. They often could go elsewhere and be better compensated.

SM: Why are reimbursement rates so low in the area?

TCD: It is because of the payer mix. When the economy is stagnant, there is a higher prevalence of Medicare and Medicaid.

SM: What criteria do you use to select physicians for SPI?

TCD: When a physician is interested in joining SPI, we conduct a formal assessment of that physician’s practice using a third party. We look at various factors, including the performance of the practice, any history of issues, and all the databases for credentialing. A potential SPI physician must be sponsored by a service line leader or a hospital CEO.

Summa also graduates 60 residents each year who want to know more about SPI. We can pick and choose the physicians we need, whereas before they might leave town because of better opportunities. The beauty of bringing them into SPI is that they already know the system and our community. We invest so much in our residents, it is nice for them to stay.

SM: Critics of physician/hospital partnerships say that the arrangement focuses too much on the economic benefits to both groups and not enough on innovative, high-quality, affordable patient care. How do you answer that criticism?

TCD: We focus on high-quality, innovative and affordable patient care – that’s exactly why we’re successful. As we move forward, we will benchmark all of our physicians, and we will pay for performance. We will be in a position to take risks on quality outcomes, and we look forward to it; I think we’ll do quite well in that situation.

SM: Now that the BioInnovation Institute is set to become a reality, will it have any affect on SPI?

TCD: It will be positive. The BioInnovation Institute will attract more research-oriented physicians who are typically used to being in a faculty plan. We can be that clinical base if they want.

SM: As Summa Health System continues to grow, how will this affect SPI?

TCD: We are building the infrastructure to support the sustainability of SPI. We went from being a $6 to $7 million organization to an $80 million organization in two years. We are looking at potentially having 250 physicians in SPI someday. We are racing to keep up, which is a good problem to have. We do a lot of education internally, we are proactive and we feel this model really works. Malissa K. Bodmann

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24 25

The Residency Research

Legacy:

When Henry Bohnert,

46, of Akron, started

experiencing chest pain

and his co-workers called

911, he did not realize

data about his heart

would arrive at Akron City

Hospital before he did.

medicaltechnology

78 Years of Significance


While en route to the hospital in an ambulance, paramedics performed an

electrocardiogram (ECG) test and sent results to Akron City Hospital’s emergency

room via cell phone technology. Less than thirty minutes later, Bohnert was

leaving the hospital’s cardiac catheterization lab with his blocked artery open

and the pain gone.

In the interim, physicians inflated a balloon to open his blocked artery, a

procedure known as a balloon angioplasty. The time between his hospital arrival

and the balloon placement, called the “door-to-balloon time” (DTB), was 25

minutes. Bohnert went home three days later and has returned to work. He knows

he was lucky. He wondered whether it was significant that his ECG test results

arrived before he did. Bohnert was not the only one wondering. A research study

by Akron City emergency medicine resident Colleen Bhalla, M.D. suggests the

answer is yes. Pre-hospital transmission of ECG data is important – it reduces

“door-to-balloon” times, particularly during off hours. Nationally, the American

College of Cardiology sets a baseline of opening blocked arteries in under 90

minutes. Otherwise, heart muscle begins to die. The goal is to reduce DTB

times for patients with fully blocked arteries, known as ST segment elevation

myocardial infarction (STEMI) heart attacks.

Before Dr. Bhalla’s study, EMS departments were sending ECG results to local

hospitals before arrival but no research showed whether this cut DTB times. By

comparing DTB times of STEMI patients whose ECG test results were sent early

against those without pre-arrival transmission, Dr. Bhalla validated this electronic

“heads-up,” particularly during off hours. It enables the ER staff to activate the

cath lab team, triggering assembly of requisite staff and equipment. This is

especially important when cath lab staffing is light, on weekends and evenings.

That Dr. Bhalla did this significant research while still a resident might surprise

some. It shouldn’t. For 78 years, research done by Summa residents has made

a difference.


summamagazine

Physicians face an onslaught of medical literature touting new drugs and procedures. Absorbing new information is daunting, but more important is deciding what is significant. Some studies demand attention – others should be ignored. Physicians must differentiate or they might make poor clinical decisions based on flawed findings. In Summa hospitals, physicians are taught to approach “new findings” with healthy

Research: a Cornerstone of physician training

the research process

The research process begins when a physician starts clinical training. Departmental leaders are key mentors.

Researchers must:

Define an appropriate question to investigate

Write a proposal for approval by the appropriate regulatory board

Conduct research

Write up results

Prepare data for oral or poster presentation in an appropriate forum

Submit an article for publication if findings are significant

medicaltechnology

skepticism and a critical eye. Conducting research is how they learn.

Nationally, doctors are generally encouraged, and often required, to do research during training. There are approximately 250 doctors training in 13 Summa residencies plus five more in three subspecialty fellowships. All emergency medicine residents and all fellowship candidates must pursue

Steven Schmidt, Ph.D., Director of Research and Director of Surgical Research for Summa Health System explains:

“Doing research makes better doctors. The research process teaches how to distinguish between good and bad science.”

scholarly activities – usually research. In other Summa training programs, residents are “strongly encouraged” to conduct research.

Some create projects while others join ongoing efforts. Most do clinical research examining patient care. A small percentage – 25 percent – chooses basic/bench research in a laboratory setting.

The hospital’s Institutional Review Board (IRB) reviews proposals involving people. The Animal Care and Use Committee (ACUC) oversees animal research.

Most doctors do not pursue full-time research careers but this does not minimize the importance of such research training. Dr. Schmidt emphasizes,

“The purpose is not to turn everybody into research scientists. It is to teach clinicians how to determine what’s best practice for their patients.”

At Akron City and St. Thomas Hospitals, residents have been making research contributions for decades. Efforts are recognized at an annual Postgraduate Day celebration, which dates back to 1931 when Akron City Hospital began its first residencies. When Akron City merged with St. Thomas Hospital, creating the Summa Health System,

Postgraduate Day: a Legacy of Science, Sport and recognition

62 Postgraduate Day events had been held, documenting decades of discoveries.

After the Summa Health System was created, Postgraduate Day remained a hallowed tradition but the numbering system began again, reflecting a new era. Thus, 1993 marked the Summa Health System First Annual Postgraduate Day.

Postgraduate Day includes a scientific meeting, golf outing, dinner and a recognition ceremony. The best projects receive awards. Though the event is fun, it also offers a serious look at resident research.

Postgraduate Day studies all show potential for stimulating ways to improve patient care. Interests discovered during residencies often ignite careers. This happened to Dr. Bhalla; she continued her research as a Summa ER fellow. It also happened to Steven Counsell, M.D., former Geriatric Medicine Chief for Akron City. After completing an internal medicine residency at Akron City Hospital in 1988 and a geriatric medicine fellowship in Indiana, he joined Akron City’s faculty in 1990, remaining until he left for Indiana University in 1997.

Dr. Counsell was pivotal in creating the nationally recognized “Acute Care for Elders” (ACE) model of elder care. He freely credits his Akron City residency with engendering a vision of elder care brought to reality in Summa’s ACE unit. Carolyn Holder, MSN, RN, ACE Geriatrics Clinical Nurse Specialist explains how patients are helped. She describes Mary, aged 84, found on the floor at home, confused,

Making a Differencedisoriented, unable to get up, and suffering from a urinary tract infection (UTI). In other settings, Mary might have been sent to a nursing home after UTI treatment, presumed to suffer from dementia. In the ACE unit, an interdisciplinary team discovered Mary’s immobility and confusion were new and that she had recently started new medications. Once medications were changed, the confusion disappeared. Helped by ACE physical therapists, she returned home.

Without an interest in geriatrics coming alive during residency, the ACE protocol might not exist. Mary is glad that interest was stimulated. Similarly, Henry Bohnert is glad Dr. Bhalla was curious about pre-arrival ECG test benefits. Research engenders curiosity leading to progress and breakthroughs.

And that, in the end, is why research matters. Lynne Pietz

28

A Day In The Life

Res

iden

cy P

hoto

200

0

Jeffery Junko, M.D. I Director, Orthopaedic Education

Best Clinical Research Project:

Tom Scharschmidt, M.D.

“Mobility-Related Functional Deficits in Older Emergency Department Patients”

Older adults are often hospitalized for illnesses not considered “acute” or life threatening. This project shows that older adults with problems hindering basic daily activities (shopping, housework, walking, transfer, transportation, meal preparation and dressing) were most likely to suffer “sub-acute” illnesses. Thus, it may be possible to reduce hospitalizations with help for basic “mobility-related” activities.


research project explanation of project

Best poster:

Alissa Erogbogbo, M.D.

“A Method for the Consistent Creation and Quantitative Testing of Postoperative Pelvic Adhesions in a Porcine Model”

Best Basic Research Project:

Allison Young, M.D.

“Use of a Direct Coagulase Test for the Rapid Identification of Staphylococcus aureus From Blood Culture Bottles”

Meritorious Research Study:

Brook Eide, M.D.

“Evaluation of Connective Tissue Growth Factor Expression in Aggressive Fibromatosis”

Best Medical Education Research Study:

Rami Ahmed, D.O.

“House Officer Evaluation and Emergency Department Wait Times”

Patients often experience painful pelvic adhesions after surgery, hindering fertility in women. In trying out new techniques to prevent adhesions, physicians are hampered by the lack of good standardized quantitative measurement tools. This project developed a way to reproduce and measure pig pelvic adhesions, holding great promise in the testing of new ways to prevent human pelvic adhesions.

The most common cause of bacterial infection is Staphylococcus. However, doctors must determine whether the patient has Staphylococcus aureus (SA) or coagulase-negative Staphylococcus species (CNS). While existing tests make this distinction, results take time. This project shows a way to quickly differentiate between SA and CNS infections testing directly from positive blood culture bottles, thus speeding up treatment.

Patients with aggressive fibromatosis suffer from benign tumors treated with radiation and surgery. Sadly, such tumors often reoccur, requiring ongoing painful treatment. This project suggests that connective tissue growth factor (CTGF) may inhibit subsequent tumor development, leading to possible new therapies.

Emergency rooms are frequently overcrowded. This study measured the time ER residents took to evaluate and transfer patients to a floor bed, documenting delays. Thus, developing new systems to enable residents to evaluate patients more quickly may be helpful.

Postgraduate Day 2008: Continuation of the Research Legacy

On June 2, 2008, the Sixteenth Annual Postgraduate Day recognized the graduation of 76 physicians. Abstracts were submitted by 44 researchers. A judging committee reviewed all submissions, selecting 15 for oral presentations and the remainder for poster displays. A review of the award winners demonstrates both quality and scope:

2008 research awards

summamagazine

4:30 a.m. The insistent buzzing

of the alarm wakes Dr. Jeffrey

Junko. An orthopaedic surgeon

specializing in the foot and

ankle, he begins his day long

before sunrise. Pulling out of the

driveway while his wife and four

children are still sound asleep,

Junko begins to focus his mind

on the patients and surgeries he

faces in the coming day.

“My mother begged me not to become a football coach like my dad, because of the demands on family time. Ironically, I think I chose an occupation that’s just as bad,” he says with a laugh.

A football player during his undergraduate years at The University of Akron, Junko never had any injuries but remembers thinking that what the team doctors did was pretty interesting. After graduating with a degree in biology, Junko did a year of graduate work at Kent State University before applying to medical schools. “I interviewed at Northeastern Ohio Universities Colleges of Medicine and Pharmacy (NEOUCOM) and was accepted the next day. I cancelled my interviews at other medical schools because I was so happy out there.”

“The day I leave Summa, people will know we’re not doing charity care anymore.”

Over the course of the day, Junko walks nearly three miles through the hallways of St. Thomas and Akron City Hospitals.

6000 STEP

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5:50 a.m. Junko begins rounds

at St. Thomas Hospital, reading

charts carefully and checking

notations and updates before

quietly going into each of his

patients’ room. If he has patients

at Akron City Hospital, he does

his rounds there first.

After finishing his first year of medical school at NEOUCOM, Junko applied to do an externship with Dr. Scott Weiner, an orthopaedic oncologist at Summa. “I’d never heard of this guy before, but I filled out an application and sent it in for consideration. For some reason, he liked me during the interview and was impressed with my curriculum vitae, so I became his protégé for the summer.”

Junko absolutely loved his experience with Weiner that summer. “Scott welcomed me into his office and the operating room, and everyone at Summa was terrific,” said Junko. “I noticed everyone at Summa taking excellent care of patients and genuinely enjoying their work and realized that I wanted to be part of that team.”

“I know that sounds corny,” Junko admits. “But it’s the absolute truth.”

7:15 a.m. Deep in discussion

during the daily hour-long

lecture series to residents,

Junko is in his element as he

carefully explains a complicated

orthopaedic procedure to a

rapt audience.

“After graduating, I did my fellowships at the University of Iowa and the University of Utah and was fortunate enough to work under some great mentors and teachers: Dr. Charlie Saltzman and Dr. Ned Amendola, both world-renowned foot and ankle surgeons,” said Junko. “It’s interesting,

because they do things a little differently in other parts of the country. So I’ve seen how we do it in Ohio, I’ve seen how the University of Iowa tackles the same kind of problems, and I’ve also been out west to Salt Lake City to see how things are handled there. I think I’m maybe a bit more well-rounded than somebody who stayed in one area the whole time.”

But he is drawn to Northeast Ohio, not because of the climate or friendly neighborhoods, but because of his passion for giving back. He credits his success to the influence of the people he’s worked with in the Akron region who passed on their knowledge to him. “Every day when I do a procedure or see a patient, I carry what they taught me and use it. I got so much from this program and from Summa that I wanted to give back to the program and to the hospital and it was pretty exciting to be offered that opportunity.”

11:20 a.m. Junko is seeing

his sixth patient of the day;

he’ll spend anywhere from

15 minutes to an hour with

each patient, depending on their

needs. Right now he’s examining

the ankle of an elderly diabetic

man whom he suspects may

have a bone infection.

In addition to his medical practice, Junko serves as the Director of the Orthopaedic Resident Education Program at Summa. This involves talking with the residents every day, overseeing their educational activities, helping them solve any problems they may be having and making sure the program adheres to ACGME (American College of Graduate Medical Education) guidelines.

2:45 p.m. He grabs a quick

sandwich and continues with

his office appointments. Junko

has office hours all day on

Mondays and Wednesdays and

does surgeries on Tuesdays and

Thursdays. Fridays he spends

at the clinic with the residents,

working with under-insured and

uninsured patients.

Part of his directorship involves overseeing the resident’s care of the indigent. “A large portion of what Scott and I do is to ensure that those people are cared for with the highest quality possible – that they are treated just the same as somebody who’s fully insured with the best insurance you can imagine – that every single patient receives up-to-date care. We don’t tell people, ‘sorry, we can’t help you because you don’t have the ability to pay.’ We take care of everyone who comes through the door because it’s fulfilling our mission,” says Junko. “If there is a costly procedure or a medical device that someone without insurance needs, Summa allows us to provide it, which is really kind of nice because a lot of places wouldn’t let you. We simply don’t turn people away.”

30

5:10 p.m. Junko heads over to

the Emergency Department at

Akron City Hospital for a consult

on a trauma case. He does this

so often, the timing is down to

a science.

Junko is looking forward to the new orthopaedic hospital currently under construction on the Akron City Hospital campus. One of the biggest changes will be the relocation of the orthopaedic residency program, which

adayinthelife

is currently housed at St. Thomas Hospital. The more central location will allow increased interaction with residents in other practices. “It’s sometimes hard to run back and forth between the two campuses. It’ll be great to have more time to actually treat patients.”

He’s also happy because the new facility will operate under the same principles that Summa has adhered to for over 116 years. “If somebody needs orthopaedic care, it will be done at this new orthopaedic

center, regardless of their ability to pay. That is the one assurance I definitely wanted to have and from everything I’ve been told, it’s not going to be run any differently than how it is now,” said Junko. “I wouldn’t feel comfortable working in an environment where I knew we were turning people away because they couldn’t pay.”

7:15 p.m. Junko pulls into

his driveway, eager to see his

family. He spends time with his

children, building Legos with

his three sons and playing with

his baby daughter before a

late dinner.

While his work occupies the majority of the hours in a day for Junko, he realizes the importance of keeping his life in balance. “I have to give all the credit to my wife, Meredith,” Junko says seriously. “She makes everything that I do possible and without her I could do none of this,” he says, gesturing around his office. She’s not shy about letting him know if he’s spending too much time at work and not enough time with his family. His commitment to his vocation is clear and he pushes himself during the week, but unless there’s an emergency at the hospital, he sleeps in and relaxes with his family on weekends. If he had more time in his life, Junko says he’d spend it with his family. “I love seeing the kids running around,” he says. “They’re so much fun and I get to be a kid again with them.”

11:05 p.m. After catching

up on some work-related

reading, Junko sets the alarm

for 4:30 a.m. and turns

out the light. Jill Y. Stefancin


32

governmentrelations

From research to surgery to education, we’ve pioneered orthopaedic breakthroughs since 1979.

Summa’s innovative orthopaedics earns

its 11th year on America’s Best Hospitals List.

Thanks to the vision of Dr. Walter Hoyt, Jr., Summa established

a unique blend of research, medical education and surgery

to create a nationally-recognized orthopaedic program. Our surgeons

work closely with biomedical researchers to give you the very best

chance of recovery. They also train the next generation of residents,

ensuring top talent stays right here in Akron. It’s worked so well,

Summa’s Akron City and St. Thomas Hospitals have been recognized by

U.S. News & World Report as having one of the top 50 orthopaedic

programs in the country for 11 years.

T o l e a r n m o r e , v i s i t s u m m a h e a l t h . o r g

Michael Askew, Ph.D., Director, Hoyt LaboratoryJeffrey Junko, M.D., Director, Orthopaedic EducationScott Weiner, M.D., Chairman & Residency Director

SUM0805.094 US News 2008 8.5X11.qxd 8/26/08 11:46 AM Page 1

Bringing Summa, and Sanity, to Washington D.C.

“If I wanted to go crazy, I would do it in Washington because it would not be noticed.”

With that conventional wisdom as a warning but not a deterrent, Summa’s leaders have been embarking on an effort to bring some sanity – and Summa’s story – to the healthcare debate in the nation’s capital.

Two sets of Summa’s leaders have made two different visits to Washington this summer.

Dr. Teresa Koenig, chief medical officer of the SummaCare Health Plan, and Dr. Kyle Allen, chief of the division of geriatric medicine, traveled to Washington to share the results of Summa’s revolutionary approach to chronic care. On June 30th, Drs. Koenig and Allen joined Tracy Carter, Summa’s director of government and community relations, in meetings with some key behind-the-scenes policymakers about how Summa’s experience – and results – can improve care and contribute to the national healthcare debate.

They presented the results of Summa’s pioneering work the past five years, under the direction of Dr. Allen – from initial trials through its Acute Care for the Elderly program (the “ACE Unit”), up through subsequent trials on diabetes care, stroke care, and after-discharge care management of low-income frail elderly (known as AD-LIFE).

In each trial, patients who received care through Summa’s ACE Unit recorded shorter lengths of stay, were less likely to have complications from their care, were less likely to be readmitted, and most importantly, have a lower mortality rate.

When these results are extrapolated out across America, there is a sense of the simultaneous improvements in care and cost savings that can be achieved. Dr. Koenig and Dr. Allen are scheduling follow up meetings with congressional committees, think tanks, and budgetary leaders to make sure that Summa’s success isn’t just a regional treasure, but a national model.

Just three weeks after that visit to Washington, Summa Foundation President and COO August Napoli joined the government relations leaders from Akron Children’s Hospital, NEOUCOM, The University of Akron, and Akron General Medical Center to share with Ohio’s Congressional representatives their vision for a BioInnovation Institute in Akron.

Napoli reminded leaders that the justifiable focus on the problems with the healthcare system has helped obscure an equally compelling truth across much of America’s heartland: in cities and states where manufacturing was once king, stethoscopes are quickly replacing smokestacks as the key to a brighter economic future.

The BioInnovation Institute offers exciting opportunities for economic development, healthcare, education and research in Northeast Ohio, and all of the leaders attending asked the congressional leaders to continue to support healthcare innovation as both an economic driver and a moral imperative.

In 1953, General Motors chief executive Charles E. Wilson famously declared that what is good for General Motors is good for America. While there’s no doubt that Summa’s success is good for greater Akron, it also appears that what is good for Summa is good for America – and that’s what Summa leaders are sharing.

The author Irwin S. Cobb once said,

32

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