The Cardinal rule

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Joyce Cardinal navigates the halls of Jefferson Healthcare Hospital in Port Townsend with easy familiarity, almost gliding as she walks. Around each corner there is a quick smile and a little wave of acknowledgement as hospital staff members weave in and out of patient rooms and administrative areas. Everyone knows her. She is the Chief Nurse Executive with broad administrative responsibilities, but she speaks softly and has the easy manner of someone who spent years reassuring and comforting patients.

“I loved bedside nursing,” she says, “and I think that’s helped me in my administrative career.”

She says her mother says she always wanted to a be a nurse from a very early age, something Cardinal does not deny.

“I wanted to be a nurse that gave out babies,” Cardinal says with a small chuckle. That seemed like a dream job because she had this vision of women getting babies and everyone being so happy. Those initial thoughts led her to volunteer as a candy-striper in high school and from there she started climbing the nursing ladder, adding degrees and qualifications and working at hospitals large and small.

Today she is a registered nurse with a master’s degree in business administration.

As Chief Nurse Executive, she is responsible for all in-patient nursing, from births to surgeries, from the pharmacy to Home Health and hospice. Her job is make sure the staff is meeting quality standards for care.

“It’s a good job and I love it here,” Cardinal says. “I have to feel like I’m still making a difference,” and at Jefferson Healthcare, a small 25-bed facility, Cardinal says it’s easy to see almost immediate results in efforts to improve patient care.

One huge, recent change at the hospital was the adoption of Epic, an electronic patient record system that integrates clinical information, health histories, registration, patient scheduling and billing in one platform. Caregivers enter information directly into the system and that patient record follows people wherever they go. If patients move from one department to another, for example, and they need some kind of special assistance, the department receiving the patient gets all the necessary information. Before Epic, those processes were more informal and there was less consistency from patient to patient and staff member to staff member.

“Handoffs are so important,” Cardinal says, referring to any time a patient moves from one caregiver or department to another. She said she likes that under Epic those processes are more formalized, but she says the new software also is bringing big changes. The system touches every process at the hospital and that has its challenges as job responsibilities and procedures are redefined.

In addition to making patient care more consistent, she said the whole process of Epic adoption has been a bonding experience with the staff. So many people put in so many extra hours to make the system work that now they all feel they’ve been through big changes together.

“We have a great staff,” she says with obvious pride.

The hospital, like all health care institutions, also stands on the threshold of changes brought by implementation of the Affordable Care Act. The legislation is complex and integrating all its requirements will be a challenge, Cardinal said. A positive side is that when more people have insurance, Jefferson Healthcare Hospital will start getting paid for a portion of the charity care it already provides. The bill for charity care in Jefferson County runs into millions of dollars each year.

While it is hard to know exactly what the impact of the Affordable Care Act will be, Cardinal acknowledged that somehow, health care institutions in the future will need to stand the entire health care process on its head, so organizations are compensated for keeping people healthy, not just for treating them when they are ill. The best way to reduce health care costs, everyone acknowledges, is to keep people healthy.

Jefferson Healthcare already has started down that road with educational initiatives and programs reaching out to the community. They hired Chef Aaron Stark to supervise hospital food services and provide healthy meals and the Home Health program aims at keeping people in their own homes longer. More efforts like that in the future will be necessary if health care costs are to be controlled, Cardinal said.

She’s in her third year now as the Chief Nurse Executive and it’s clear that the job is a personal labor of love.

Unlike big city hospitals where you might never know any of the patients you serve, “In here, we’re taking care of our friends and neighbors,” she said.

That makes her efforts to improve the quality of care doubly important. At the beginning of their quality care initiatives, the staff gathered all kinds of data on patient outcomes and patient opinions and started focusing on different areas to see if they could raise their standard of care.

Staff members were offered more training, processes were examined and revamped, and today the hospital is seeing the results of those efforts.

Consumer Reports recently ranked Jefferson Healthcare alongside Swedish Medical Center in Seattle and five other hospitals as the top hospitals in Washington to have surgery.

Jefferson Healthcare also recently was designated a Baby-friendly Hospital by the World Health Organization. It is only the fifth hospital in the state and one of 128 in the United States to achieve this title. The Baby-friendly Initiative recognizes hospitals that implement best practices in breastfeeding support for new mothers.

Cardinal says she is especially proud of the Baby-friendly designation because it was a nurse-driven process and because the staff was focused on making it happen.

“They worked really hard at it. That’s what makes me proud,” Cardinal said.

She is part of the senior leadership team at the hospital and she oversees a diverse and complicated health care delivery system that is changing every day. And even as the whole world of health care morphs and evolves, Cardinal keeps her focus guided by the lessons learned at patient bedsides.

“I’ll be a nurse until the day I die,” she says. “It’s been a great career.”
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