St. Charles Medical Center (SCMC) in Bend, Oregon, is a 261-bed tertiary medical center serving central and eastern Oregon. It is the only tertiary medical center within its 33,000-squaremile service area. It offers a broad scope of services, from open heart surgery to rehabilitation, and averages a 4.0-day length of stay. It is a Level II trauma center and has a Level III neonatal intensive care unit. In 2001, St. Charles was the cornerstone of a newly formed health system, Cascade Healthcare Community, which changed to St. Charles Health System (SCHS) in 2010. SCHS now includes St. Charles Medical Center in Bend, St. Charles Medical Center in Redmond, a 50-bed community hospital, Pioneer Memorial Hospital in Prineville, a 25-bed critical access hospital, and one additional managed critical access hospital. There are also a number of physician clinics and partnerships in the region.

St. Charles has had a history of notable national recognition since 1993 when it was awarded the Healing Healthcare Projects’ organizational award for its vision and implementation of healing healthcare and the patient-centered approach. In 2000, St. Charles Medical Center was honored with the Norman Cousins Award for relationship-centered care and noted by the selection committee as “the best hospital in the country with regard to the sacredness of care.”¹¹ St. Charles continues to be highly rated for clinical excellence, patient safety, emergency medicine, women’s health, coronary intervention, critical care, and orthopedic and spine surgical excellence. St. Charles Medical Center was further recognized by Thompson Reuters (formerly known as Solucient), a leading source of healthcare intelligence, as a top 100 hospital in areas of quality of care, financial performance, operational efficiency, and adaptation to the environment.¹² Again in 2009, 2010, and 2011, SCHS was rated in the top 50 health systems in the nation for quality and service by Thompson Reuters.

St. Charles, like many hospitals, strives to keep pace with change and address the needs of the rapidly changing healthcare environment in the United States. The healing healthcare philosophy foundation has helped to guide the hospital in intentionally preserving and enhancing its mission during chaotic times. The senior leadership and CEO James Diegel recognize that applying the philosophy is not only the right thing to do, as it enhanced the hospital’s mission—to improve the health of those it serves in a spirit of love and compassion—it is also the smart thing to do. People choose SCHS because of the healing nature of its service. The philosophy helps recruitment and retention because caregivers prefer to work in an environment that supports healing. When the environment is healing for patients, it is also healing for the people providing the care. The differentiation of service and
care through the healing healthcare philosophy is now considered the system’s historical icon and cultural strength. The main applications of the philosophy are healing ourselves, our relationships, patient-focused and family-focused care, environmental design, life skills, life-death transition, arts in the hospital, healing our community, and a principle-based care model.

Embracing a healing philosophy and integrating it into organization culture takes intention, time, and patience. It also takes a willingness to learn and change continuously based on current climate and learnings. Early in the healing healthcare philosophy implementation, it was believed that St. Charles needed to create something tangible so that people could easily understand the philosophy.

Nancy Moore, the St. Charles chief nursing officer and inspirational leader for nearly 30 years, recalls a pivotal moment that dramatically informed St. Charles’s understanding of healing. She was working with the design task force, leading them toward a decision to create a wellness program. A nurse held up her hand and said, “What about us?” In her wisdom at the time, she replied, “Oh, we will get to us, but first we have to take care of the patients.” Given all the turmoil and emotions of a major restructuring effort, it became clear that it would not matter what was done for the patients if the caregivers themselves were not cared for in the process. A state-of-the-art wellness center could be created and change the organization to bring each of the disciplines involved in a patient’s care to the bedside, but if the caregivers themselves were not healed in the process, it would be an empty shell. No one would want what was created.

It became crystal clear that the essence of healing is in our relationships. This is a human service; who we are and how we work together is what our patients and their families receive. We use technology, but, by and large, it is an extension of ourselves that affects healing. At that time, the group also recognized that many of us did not learn from our family of origin, or during our formal education, the skills and attitudes necessary for healthy relationships.¹³ As a result, St. Charles developed personal growth and development workshops, initially called People-Centered Teams: Healing Our Workplace that has evolved to training called People Skills. These workshops provide an opportunity for participants to reflect on what is most important to them and identify belief systems and behaviors that can support them in getting more of what they want. Participants learn to create healthier relationships through improved personal awareness, listening, and differentiated communication. They explore how broadening their personal “comfort zone” can increase individual flexibility and internal resourcefulness. Participants also discover ways to contribute their unique talents, skills, and experience more fully to the work they do and the people they serve. Participants report that the skills help them not only in their work, but also in their personal lives.

In recognition of the increasingly stressful work environment, St. Charles Health System offers a workshop in collaboration with HeartMath LLC, based on research from the Institute of Heart Math. The workshop, called Transforming Stress, provides an opportunity for caregivers to learn the tools of “inner quality management,” based on utilizing positive emotion to affect the physiologic response to stress. Caregivers learn to achieve a state of “coherence,” which supports them in detaching from stress, thinking clearly, listening more effectively, and improving resiliency and renewal.¹⁴ Since 2005, nearly 680 caregivers have completed our Heart-Math workshop. Figure 26-1 shows the result of studies conducted at the Institute of HeartMath with data provided from St. Charles caregivers who completed preworkshop and postworkshop assessments. The standardized scales on this page are coded so that the desirable end of the graph is toward the top, where substantially above average would be a commendable result and substantially below average would be a poor result. As illustrated, St. Charles caregivers have experienced improvement in perception of well-being and health, stress level, reported depression, and sense of peacefulness after participating in the HeartMath workshop.

St. Charles nurses who are certified to provide therapeutic touch find HeartMath tools useful in centering both the patient and themselves prior to delivering therapeutic touch. In 2011, the workshop was updated to include a greater
focus on caregiver resiliency and genuine caring in the healing environment.

Other resources to support healing ourselves and our relationships include our caregiver assistance program (CAP) and critical incident stress debriefings. CAP offers confidential counseling that is available to caregivers and their family members free of charge, as well as assessment and referral to appropriate resources. The critical incident stress debriefings are available through social services for teams or individuals experiencing unusual amounts of stress, such as caring for many critical patients for a prolonged period of time or helping in a trauma or intense response to an incident.

Research indicates that the most effective way to promote healing is for patients to become actively involved in their care.¹⁵,¹⁶,¹⁷ Patient-focused and family-focused care actively involves patients and family members or significant others, as the patient desires, in the care process. This type of care provides services based on the patient’s needs. A 2005 study of family members’ contribution to care of patients in ICU identified that it was through contact with the family that ICU nurses come to know more about the person for whom they are caring. Family provides a vital source of emotional support to the patient and, in fact, reduces patient anxiety.¹⁸

When SCMC designed and built the initial electronic medical record (EMR) in 2003, the intention was to utilize the technology to cue nurses to think about family involvement in care. The transition to new technology in 2009 continued to focus on building prompts to cue nurses to focus on patient and family needs. The admission history includes questions about patient and family preference for involvement in hygiene, meals, overnight stay, and sitting with confused patients.

St. Charles Medical Center also identified that one of the major sources of nurse burnout is that nurses often work from their assumptions of what the patient needs. This can lead to unsatisfied
patients as well as burned-out nurses. Most nurses are conditioned to try to meet all of the needs they can identify for the patient whether the patient identifies them as needs or not. When nurses were students, they learned that if they missed a patient’s need in developing the care plan, it often meant a lower grade. Nurses transfer this learning to the work setting. Every day nurses would go home feeling frustrated and angry because they couldn’t meet all of the needs they identified for their patients. There is always more work to do than time to do it. Prioritizing care based on the patient’s needs as identified by the patient is one of the most important nursing skills. St. Charles introduced a consistent service standard, Sharon K. Dingman’s the Caring Model, to address this need and because of the success continues to use this model. The Caring Model consists of five behaviors that are part of an organization-wide or nursing department change initiative.¹⁹ Exhibit 26-1 lists the Caring Model behaviors.

Nurses are one of the most important therapeutic interventions. Nurses are people caring for people. They use technology, but it usually is as an extension of themselves. During orientation, all new caregivers are introduced to the Caring Model and asked to reflect on their own experiences as a patient and to identify what helped and what impaired the healing process. The most commonly mentioned factor is almost always the attitude and communication of the nurses. Where healing was enhanced, the nurse’s attitude was described as caring, procedures were explained in advance, and education was integrated into care. This realization, and the need for enhanced anxiety and pain management, led to the development of the workshop Pain and Anxiety Management: Integrating Healing HealthCare Principles.²⁰ Key among these core competencies is therapeutic presence, which is outlined in Exhibit 26-2.

Additional pain and anxiety management competencies include several modalities that can be offered and taught to patients. The intention is to assist patients in accessing their own natural healing abilities. These methods enhance rather than replace conventional medical interventions, helping patients to help themselves and heal faster. Exhibit 26-3 describes the performance criteria and validation methods for these competencies. Clinical caregivers (nurses and nonnurses) are required to complete an initial competency validation when hired, and an annual refresher is required via a computer-based learning module. A checklist form is built into the electronic medical record so that clinical caregivers may simply check a box when they have administered one of the healing modalities learned in the pain and anxiety management competence workshops, such as therapeutic touch, guided imagery, intentional breathing, and progressive muscle relaxation.

Patient-focused and family-focused care also requires attention in architectural and environmental design. Healing design is design with intent to give as much control to the patient as possible (temperature, lighting, etc.) and to create a home-like environment with access to natural light and views of nature.⁹ Prior to implementing the healing healthcare philosophy at St.



Charles Medical Center, one of the most common patient complaints was concerning the quality of the food. Best practices for food services were researched, both inside and outside of the healthcare industry, including such sites as the Ritz Carlton. The results were applied in 1999 by hiring a chef and implementing room service 24 hours a day, 7 days a week. Today room service is provided so that patients select what they want to eat and when they want to eat it from a bedside menu. Special diets are noted through a computerized system and patients are helped with their choices if they choose an excluded item. The meals are delivered within 15 minutes. This practice has saved thousands of dollars in food waste and enhanced patient satisfaction. St. Charles was the benchmark for food service satisfaction for more than five years and hosted many site visits for other hospitals that have since adopted room service as a best practice. St. Charles remains in the top 15 percent of the comparison group with satisfaction of the quality of food services.²¹ In 2009, SCHS also initiated a summer farmers market on the hospital grounds, inviting local growers to offer organic fruits and vegetables to the community and caregivers. It is a tribute from the community that the hospital café and cafeteria are a gathering place for lunch, meetings, and catered conferences.