Spring 2022 | Volume 103, Number 2
Over the past two years, the pandemic has exposed significant gaps and weaknesses within the U.S. health care delivery system. Although the speed of the development, approvals and distribution of COVID-19 vaccines in the U.S. strongly make the case that our health care system remains one of the best in the world, we still have much room for improvement and have made significant findings about issues that need to be addressed.
At the start of 2020, Dr. Jim Heath was looking forward to kicking off a yearlong celebration marking the 20th anniversary of the Institute for Systems Biology, a Providence-affiliated nonprofit biomedical research organization located in Seattle'sSouth Lake Union neighborhood. Heath was named president of the institute in 2017 and was excited to share its research — and more about its researchers — with the public. The chemist-turned-biologist was also deep in his own research projects that included immunotherapies for cancer, among others.
MARGARET R. McLEAN, MDiv, PhD
Around every corner of the COVID-19 pandemic await questions of ethics, perhaps none so unanticipated and vexing as the fair distribution of scarce medical resources. Beginning on day one of the pandemic with a shocking lack of personal protective equipment (PPE), patients and professionals have faced a reality long slumbering, undisturbed in the bowels of the decentralized health care system in the United States: the rationing of health care resources. In emergency rooms from coast to coast, the pre-pandemic default of seeing all comers became impossible and treating based on need was supplanted by the calculus of cost-benefit. Scarcity affected ventilators, staffed beds, antivirals, monoclonal antibodies, oxygen and blood products — a sign of failing preparation for a global public health crisis.
Health care systems across the country have transformed the delivery of patient care, with telehealth programs in particular expanding during the coronavirus pandemic. The field of telehealth has seen dramatic shifts — mainly out of necessity — as patients experienced limited access to in-person health care services during COVID lockdowns. For many health systems, embracing virtual care services for patients prior to the pandemic's start proved to be a key factor in their systems' quick adaptation to the changing health care environment.
Shortly after Erik Wexler started as Providence's chief executive for the Southern California region, his chief mission officer told him that he would need a two-year formation course — one weekend per quarter — and to clear his calendar.
SHEILA GIFFEN, MD
While much attention has been focused on the physical and emotional strain of providing care during the COVID pandemic, there's been less discussion of the extraordinarily rapid rate of change it has brought. As administrators and clinicians constantly assess how to best care for patients, a closer look at what one health system experienced in Idaho reveals why an evolving response to care has been so vital during the past two years.
DANIEL A. GRAFF, PhD, and KELLI REAGAN HICKEY, MS
As an X-ray reveals a broken bone hidden beneath the skin, COVID-19 has exposed the economic fault lines fracturing our society and highlighted the costs endured by workers over the past several decades. As exemplified in a 2021 survey, nearly one infour nurses say they are considering leaving direct patient care within the next year, while almost one in three frontline health care workers more generally report the same.1
Nurses cite multiple factors for their dissatisfaction, with six reasons polling higher than pay, including insufficient staffing, excessive workload, emotional toll and not feeling listened to or supported by management.
JENNIFER STANLEY, MD
I am tired. I take that back: I am exhausted.
The past two years have been unlike anything I have ever experienced. Looking back, medical school was tough. My fellow classmates and I studied, worked together and got through it. Residency was tough. My fellow residents and I stuck together, held each other up. We helped one another out, graduated and found great practices in which to begin our vocations. Postpartum depression was tough. I leaned on my close friends who reassured me that my newborn son, Walt, would be an amazing kid even if he was formula fed — and they were right. The start of this pandemic was tough, and we banded together with our colleagues and stuck it out — we were even called heroes.
M. THERESE LYSAUGHT, PhD, and SHERI BARTLETT BROWNE, PhD, MA-HCML
In 2015, Georgetown University confessed a painful secret: the Maryland Jesuit Province had sold 272 enslaved Blacks in 1838 to secure the struggling university's future.1
Almost two decades earlier, three congregations of religious women in Kentucky that had enslaved Black people — the Sisters of Charity of Nazareth, the Sisters of Loretto and the Dominican Sisters of St. Catharine — began a similar journey to acknowledge and atone for their past. And in 2016, the Leadership Conference of Women Religious (LCWR) adopted a resolution to "examine the root causes of injustice, particularly racism, and our own complicity as congregations," a resolution that garnered little action at the congregation level until reignited by the murder of George Floyd in 2020.
ELIZABETH SHULMAN, DMin, STNA
"When we are no longer able to change a situation, we are challenged to change ourselves." These words by Holocaust survivor Viktor Frankl can offer brilliant guidance to those caring for someone with Alzheimer's or another dementia-related illness. There are more than 16 million dementia caregivers in the U.S. Not surprisingly, a sense of burden and depression are two of the most researched areas in the field of caregiving.1
Whether it's limited support, a response to their loved one's behavior or just a general sense of loss, it is not unusual for caregivers to wish things were different in some way. However, when a stressful situation offers no immediate solution, caregivers may discover a sense of hope and well-being not by changing their actual circumstances, but by changing how they look at their situation.
SARA DAMIANO, LMSW, CCM, ACHP-SW, and RAFAEL BLOISE, MD, MA, MBA
With a commitment rooted in the loving ministry of Jesus, we are called to care for people living with serious illness, especially those who are poor and vulnerable. This is a pressing concern as nearly 30% of the adult population in the United States has multiple chronic conditions, this number predicted to rise with the aging of the population. Studies have shown that most people living with a serious illness experience inadequately treated symptoms, fragmented care, poor communication with their clinicians and strains on their family caregivers. People living with multiple chronic conditions account for a disproportionate share of health care utilization and costs, as almost half have functional impairments, and nearly all readmissions among Medicare beneficiaries occur among this group. Similarly, health care costs and spending continue to grow, which further widens the gap in access to affordable care, thus contributing to health disparities.