A New Era in Health Care

Multiple Affiliations Enhance Health Education

Two of Creighton's educational partners recently made announcements that could provide even more opportunities for Creighton health sciences students. Read more

Center Earns Significant Grant

The College of Nursing and Creighton’s Center for Interprofessional Practice, Education and Research (CIPER) have earned a $50,000 grant from the nation’s premier organization promoting interprofessional and community-based health initiatives. Read more

A New Era in Health Care

By Cindy Murphy McMahon, BA’74

Anna Worley, BS’10, MD’14, knew she wanted to be a physician from an early age. “I always knew I wanted to lead a life of service to others,” says the two-time Creighton graduate. “In my mind, when I think of being a physician, the image of Christ washing the feet of his disciples always comes to mind. To me, medicine, in its purest form, is about humility and service to those in need.”

Now, her goal is in sight, as the 29-year-old nears the end of her professional training as a third-year Creighton family medicine resident. Medical school and residency have only furthered her resolve and deepened her commitment, but the nitty-gritty reality of health care delivery is the realm she lives in now. At the clinic where she primarily practices, she treats refugees from other countries, some of whom have faced unspeakable hardship.

“I was initially intimidated as to how I would relate and connect with patients whose life experiences so vastly differed from my own,” she says.

“But the amazing thing is that I have realized the things that make us different are so minor compared to the things that make us the same.”

One particular Nepali refugee woman is forever imprinted in her mind.

“I can remember being on labor and delivery, gowned and gloved, working with my patient who was soon to deliver. As I sat at the foot of her bed, seven months pregnant myself, I can distinctly recall this incredible feeling of connectedness, my own baby boy kicking as I guided her perfect baby boy into the world.”

During the time Worley first left her rural Nebraska home in 2006 as a pre-med student majoring in biology, earned two degrees, married and became a mother, the U.S. health care environment has been undergoing unprecedented changes. As her career progresses, it will look vastly different from when she first envisioned donning a white coat and stethoscope.

For starters, care is expected to focus more on health than sickness. People will be more likely to have conversations with physicians and nurses about how to stay well than to have office visits for illness.

“Interprofessional” teams of nurses, pharmacists, physicians, social workers, therapists and other providers will collaborate on care, sparing patients multiple appointments with various caregivers and improving communication while driving down cost.

Hospitals will be fewer and smaller, and used less often.

This health care world, which is right around the corner, represents a transformation to expand access, better control costs and improve the quality of care. And it is the world for which Creighton health professions students and residents are being prepared.

This is not the first time Creighton has been at the front lines of change in health care.

The year was 1977. Creighton University was embarking upon an exciting new chapter in health sciences education with the opening of St. Joseph Hospital on the western edge of campus. Medical, nursing and other health sciences students and residents would be exposed to the latest developments, such as a short-stay surgery center, Nebraska’s first LifeFlight helicopter service and a pod-concept that placed all patient rooms within 20 feet of a nursing station.

Now, nearly four decades later, as Creighton prepares to move from its primary teaching hospital on North 30th Street in 2017, the University is trailblazing once again.

Through a wide range of offerings in the health sciences — medicine, nursing, dentistry, pharmacy, occupational and physical therapy and emergency medical services — Creighton students are studying, researching and practicing clinical care, collaboratively and interprofessionally.

“Creighton is pioneering the future of health care in the United States,” says the Rev. Daniel S. Hendrickson, SJ, Creighton’s president. “Even the architecture of our evolving classrooms, laboratories and clinics brings these powerful professions into collaborative exchange.”

The University and its primary clinical partner, CHI Health, are poised to implement new approaches — indeed a new paradigm — in an academic health system that educates health care professionals who are ready to meet the evolving needs and challenges of the health care landscape.

Next year, CHI Health and Creighton University will open the doors to a new academic health center with two campuses. Closest to Creighton, at 24th and Cuming streets, will be the University Campus of CHI Health Creighton University Medical Center, an outpatient community health and diagnostic center with the area’s only freestanding emergency department. A few miles away, in south-central Omaha, will be the Bergan Mercy Campus, including a multistory clinic, Level 1 trauma center, inpatient facility, offices, classrooms and more.

“We are creating something that will evolve beyond what we can imagine today,” says Robert “Bo” Dunlay, MD’81, dean of Creighton’s 124-year-old School of Medicine. “We are now poised to carry our mission into the future much more effectively than we would have been able to before our partnership with CHI Health.”

To understand the significance of the University’s partnership and plans with CHI Health, the largest health system in the region, it is helpful to understand the steps that led to the affiliation and briefly explore the roots of the two Catholic organizations.

In 2012, Creighton strengthened its affiliation with regional Catholic health system Alegent Health, which had long been one of the University’s partners in providing clinical sites for Creighton health professions students. The affiliation agreement, which resulted in a combined organization named Alegent Creighton Health, included the transfer of School of Medicine physician faculty employment from the University to Alegent’s physician group.

Almost simultaneously, Alegent Creighton Health joined with what was then CHI Nebraska to form what is now known as CHI Health. Creighton was relieved of all financial exposure for clinical activities and gained vastly increased opportunities for student and resident training at the health system’s 15 hospitals, two behavioral health centers and 140 clinics in Nebraska and southwest Iowa.

“The boards of both organizations saw that to realize their full potential, it was better to come together,” Dunlay says.

CHI Health is itself a regional unit of Catholic Health Initiatives, or CHI, the nation’s third-largest nonprofit health system, operating 103 hospitals in 18 states. CHI was created in 1996 through the joining together of four Catholic health systems that sought to preserve and extend Catholic health care in the United States. Today, the system includes hospitals and other facilities originally sponsored by at least 17 Catholic religious communities, as well as a number of facilities that were not religiously affiliated. The vision of the founding congregations emphasized the continuation of Jesus’ healing mission, with a special concern for those most in need and an expectation that the new system would transform health care to create healthier communities.

In October of this year, the national CHI organization signed a nonbinding letter of intent with San Francisco-based Dignity Health to “explore aligning their organizations.” Dignity Health operates 39 hospitals in 22 states, including

St. Joseph’s Hospital and Medical Center in Phoenix, which already has an academic affiliation with Creighton. Plans were recently announced to expand that partnership through a newly created and tentatively named Creighton University Arizona Health Education Alliance.

“During a time of great disruption in health care such as our country is experiencing now, there are a few very large, very well-endowed universities that can afford to own their own health care systems, but we are not one of those,” Dunlay says. “So we need to partner with an institution that shares our values and creates a natural venue for health care education. We can’t afford the risk of owning our own health care system — it’s just not wise.”

Dunlay added, “Through this affiliation, our world is expanding. We have seen an increase in the number of places where our students can receive education as well as a greater variety in the type of faculty who are interacting with our students.”

“For us, it really is coming home to our heritage by joining together with CHI Health,” says the Rev. James Clifton, SJ, associate dean for mission, who serves as secretary of the board of directors of CHI Health. CHI Health’s Catholic roots include major facilities founded by the Sisters of Mercy and the Sisters of St. Francis of Perpetual Adoration.

“From the founding of the School of Medicine, it was John Creighton’s wish that the Mercy and Franciscan charisms, which shaped the original Creighton Memorial St. Joseph Hospital, would intermingle with Creighton’s Jesuit heritage to produce a special kind of health care professional,” Fr. Clifton says. “The Sisters of Mercy and the Franciscan Sisters were two of the four founding congregations of CHI, and those charisms are vibrant within our local partner, CHI Health.”

There’s total agreement from Cliff Robertson, MD, CEO of Omaha-based CHI Health, as to the like-minded missions of the two organizations in the new academic health system.

“As a Catholic organization, our mission is incredibly well-aligned with Creighton’s,” Robertson says. “Our real purpose is to serve those who are in need and particularly those who are in the most need.”

Robertson says that as a member of the national CHI organization, CHI Health is committed to delivering excellent care, regardless of whether a patient has “great insurance” and is able to pay for care.

“That’s a unique and distinctive position in our faith-based mission that ties back to our founders and aligns perfectly with Creighton’s mission to serve those in need.”

CHI Health provided about $140 million in charity care in 2015, the most recent figure available. “In addition to its outright charity care, CHI Health assists those who are working — but who cannot afford surgery or a hospital stay — through a very robust financial assistance program,” Fr. Clifton says. “We know we can’t do everything on our own, so we partner with other agencies to try to help in every way we can.

“And, going forward, the University Campus will be the largest and most comprehensive CHI Health clinic in the metro area and the only clinic in the region with 24-hour emergency services. We chose to include a full ER in this facility in order to maintain very high-level service to the neighborhood that has trusted us to care for them for many, many years. This is a significant commitment to care for the underserved.”

Have there been bumps in the road in the integration of the two organizations? Sure.

Some of the major issues have been related to the structure of the faculty practice plan, ways to integrate the academic mission into CHI Health and the transition to the two-campus academic health center.

“When you merge two organizations as we are doing, everything doesn’t mesh perfectly right away,” Dean Dunlay says. “Both organizations have to be willing to compromise on some things in order to create a culture that enables us to fulfill our mission more effectively for the greater good of those we serve.”

Organizational cultures also come into play as more than 500 medical students, residents and fellows and more than 1,000 nursing, OT, PT, pharmacy and EMS students will be trained annually within CHI Health facilities.

“CHI Health is one of the top performers in the CHI national system, in regard to quality, patient safety and finances. We’re integrating a renowned academic institution into a highly performing community tertiary health system,” Robertson says. “We will be successful when we can say we’ve been able to take the best of the academic and the best of the community and put those together into a new model.”

“With different cultures, priorities are sometimes different,” Fr. Clifton says. “So, now our shared priority is the best possible care for the patient and the best possible learning opportunity for students. It’s a big challenge for both organizations and calls both of us to new ways of doing things.”

Integration issues are far outweighed by the enthusiasm leaders from both organizations share about the possibilities the partnership offers.

Fr. Clifton says he views the present moment on a 10-year time frame. “We’re just starting our fifth year and already we’re about to move into a robust and unique academic health center setting with two campuses. We have the opportunity to pilot, for the national CHI system, a new approach to ambulatory, or outpatient, care that’s much more interprofessionally based, assisted by research, aimed at creating the best outcomes for patients. We have the opportunity to bring the advantages of academic medicine to the wider system, while creating incredible opportunity for our learners.”

In referring to the new outpatient University Campus, Dunlay says the facility will be “a laboratory where interprofessional groups work together to discover the ideal makeup of health care providers, patients and community involvement to prevent disease. It’s a different goal, a different paradigm than we’ve had in the past.”

In the interprofessional model, a nurse care coordinator, physician, pharmacist, social worker and appropriate therapists and specialists all meet with a patient, sometimes at the same time, and then together decide what the patient needs to achieve optimum health and remain healthy.

This is a big change in academic health sciences education, as are the plans for the Bergan Mercy Campus.

“Our inpatient education needs to be focused on high-intensity experiences that are of relatively short duration for patients, since an ever-increasing amount of health care will be moving to outpatient clinics,” Dunlay says. “Our goal is to have campuses that are technologically advanced and innovative, and programs that are cutting edge in quality and cost-control.”

Michael White, BS’96, MD’01, chief academic officer, is tasked with making sure there are opportunities for all of Creighton’s health sciences students, residents and fellows at the CHI Health facilities. Creighton health sciences schools include the School of Dentistry, School of Medicine, College of Nursing and the School of Pharmacy and Health Professions.

“We need to have access to carry out our mission to educate health care professionals from all of our schools and colleges, as well as to have opportunities to offer patients participation in clinical research,” he says.

White, who also is a practicing interventional cardiologist, says he is especially excited about the cutting-edge opportunities the University Campus offers learners.

“The unique piece to this is that we can develop a relationship between an emergency department and a team-based clinic so that we can get our patients into the right care environment as they come into the facility. If it’s a true emergency, we can help them, but if their problem can be better handled in another way, we have the providers to help them, right there, right then.”

The care provided at the two campuses “is not going to be practiced the traditional way health care has been practiced at CUMC or other CHI Health facilities,” White says. “We are going to come together in a new care model that we create together.”

All of the CHI Health hospitals and clinics will ultimately benefit from the learning opportunities that take place at the two academic health campuses. “The energy and the enquiry that are generated and piloted at the two campuses will spread throughout the system,” White says.

Centers of excellence as well as clinical research also will be enhanced through the partnership. A research institute, jointly owned by Creighton and CHI Health, is planned that will support both organizations’ research efforts.

“We are serious about preparing for a new future based more around care that is delivered outside of the hospital,” CHI Health’s Robertson notes. “Will we still need hospitals? Will we still need ICUs? Yes, but hopefully a lot less than today because we will be better and better at caring for people in other venues.”

Robertson says the academic elements Creighton brings to the partnership are key. “The academic aspect is incredibly important because we do need to prepare our next-generation clinicians for the world they’re going to be in, not for the world that I trained in 25 years ago.”

Dean Dunlay acknowledges that the closing of the former Creighton hospital next year will be difficult, producing a sense of loss for many who trained there or were cared for there, but he says the academic health system partnership has an exciting and brilliant future.

“We don’t think of ourselves the way a secular medical school would,” he says. “We admit students to our school who are called to the vocation of medicine, and our goal is to prepare them for a lifetime of spiritual, emotional and professional growth. We have the opportunity to form health care providers who will spend their lives practicing and reflecting what they learn here in support of our Jesuit, Catholic mission. And this partnership greatly enhances our ability to do that.”

When family medicine resident Worley reflects on her professional journey so far, she notes that change has been ever-present.

“Medicine is changing rapidly. Even in the seven years since I entered the field, I have seen huge changes. Change is scary, but it’s also exciting as it brings opportunity to fix things that are broken so that we can become even better health care providers.

“I’m grateful to have done my training at Creighton because I believe it has made me a better person as well as a physician,” Worley says. “Cura personalis (care for the whole person), a phrase alumni know so well, is at the heart of our training, and with that perspective, we cannot go wrong — no matter how medicine changes.”