Gabriel Perna | March 31, 2021
There may have been no better person equipped to lead Tucson Medical Center (TMC) through the past year than Judy Rich.
After all, she has experience in guiding the hospital through crises. After a two-year stint in consulting, Rich came back to TMC in 2007 during a time when it was losing about $1 million per month, she says. She worked to stem the tide of losses that incurred because of the poor economy and a merger gone bad. She had to reinvent the hospital and help it become the preferred provider within the community—and through her efforts, the hospital has enjoyed ten straight years of market share growth.
Flash forward and this expertise has helped Rich lead TMC during the COVID-19 pandemic. Arizona, with an older population, has been one of the hardest hit states in the country. Over the course of the past year, the hospital has been hit with a number of surges.
“Every time the numbers went down, we felt we were going back to a less stressful time and then we’d get hit again,” Rich says. “What we have now is a workforce with real PTSD and a workforce, primarily with the frontline caregivers, so physically and emotionally tired that they’re even having a difficult time articulating how they feel. A lot of them are withdrawing. Our turnover has gone up in nursing and we are pulling every possible support system out that we can to keep them going.”
This has meant offering employee wellness initiatives that go beyond the scope of a traditional benefit. One of the most prominent examples is the opening of a school on campus for children of frontline providers. The distance center is based on a pilot for the Higher Ground system, Restart SMART (Stronger, Mindful, Agile and Aware, Resilient and Trauma-Responsive). Higher Ground is a nonprofit organization in Tucson that works with youth and families.
Health Evolution spoke to Rich about the decision to open the school, addressing wellness in a post-pandemic environment and more.
Health Evolution: What made you guys decide to open the school on campus for frontline workers?
Rich: It started with a conversation with a mother who said her nine-year-old daughter, who was previously full of life and spark, had become depressed and was talking about taking her life because she hadn’t been in school for so long. Out of that came a need for me reach out to the local school superintendents. I sent a letter to them that said, “My staff have people who need them at home. They are conflicted between working here and taking care of patients and staying home with their children, who in many cases are depressed and starting to feel the long-term effects of this. Please open the schools again.” Of course, I cited the information we had at the time, which showed the transmission was low in elementary schools. This was an elementary school ask. It wasn’t for middle or high school students. Elementary school students are the children who can’t be left home alone.
I only heard back from one superintendent, who gave me an appropriate answer. He said they were trying very hard to do it. The largest school here – the chairman of the board – actually wrote back to me in not a very complimentary way to tell me “no, we’re not going to open.” At that point, I had a contact who put me in touch with Higher Ground. Very quickly we came to a philosophical meeting of the minds, “You know how to take care of children. You’ve got skill in this. You’ve got capacity. I have a whole bunch of people who need school.”
And so, we opened the school on January 4 with 50 children in a space we had vacated when we moved our pediatric therapy department to a new building. The feedback I get from moms, dads, and children has been 100 percent positive.
Health Evolution: How does it work?
Rich: It’s open 11 hours per day because most of our nurses work the long shift. The kids get dropped off early in the morning and picked up almost past dinner time. It’s been wonderful. There is recess and play, and lots of encouragement on how they are doing in their schoolwork.
We have about six different school districts that are represented by our area. These children are all in virtual school. They come to TMC school every day with their computers and instead of sitting at home, getting online, and doing their schoolwork that way, they have facilitators who are responsible for these children. The facilitators help them get online, help them with homework and help them get ready for class. In between class, and there’s a lot of in between time, we have a playground outside, they have games that they play together, they have facilitated study halls and social interactions with other children. It’s a very social situation compared to where they’ve been for the last year. From March to January, they were very isolated.
Health Evolution: What are the plans for the school going forward?
Rich: If the children had their way, they’d stay in this school. They’ve grown very fond of their new friends and their new teachers. Our plan is to keep it going until the school year ends in May and we’ll close it for the Summer. There’s always a possibility that we may do something else, either a before or after school program. We’re waiting to see what happens with that. I’m hearing, just the last few days, that they’re starting to have some concerns with variance in children. We will be watching the science very closely and whatever the need is to keep our staff here taking care of patients, we will respond appropriately. We do charge 15 dollars per day per student. We are subsidizing the rest of the cost.
Health Evolution: Coming out of COVID, what needs to be done in a larger context, from the federal government and all relevant stakeholders, in addressing the challenges of employee wellness in health care?
Rich: I don’t see this as a federal or a state responsibility. I am very aware of the fact that this has been a horrible pandemic for every person in this country and world. Health care has been given a lot of attention and respect because we were ground zero for what everyone could see. I believe there is pain everywhere. I don’t see a need for someone else to come in and provide health care employee wellness. We expect to be compensated for the care we provide. We expect insurance companies to do their part in that. We have an agreement with the payer who does the TPA for our self-funded employee insurance, where our employees can get assistance at no charge. Our insurance company is in that with us, so that’s part of their responsibility.
But I believe as a large employer and someone in health care, it’s my responsibility. It’s the board’s responsibility. It’s the responsibility of all of our leadership to be creative and take care of our own employees and to advocate for considerations from payers. We have a large Medicare, Medicaid, and commercial insurance population here. What makes the organization financially viable is getting paid for the work we do. We expect to be paid fairly for that. It’s our responsibility to take care of our employees and our community. We are a community hospital. We only exist to serve our community. We don’t pay shareholders. We don’t make a profit. We invest what we have. It’s pretty clear that we have to take care of our own.
I think the culture of the organization is what makes people want to be here. Obviously, we have to pay a market wage and we believe they are going to be market pressures, as we have more demand for health care employees and the supply may be limited. I’ve heard more people want to go into nursing, I’ve heard more people want to get out of nursing. We’ll see how that all shakes out, but I do believe that the culture of the organization is what makes people want to work in an organization like this.