The Ireland Report on Succeeding in Women's Health
8 The Ireland Corporation/The Snowmass Institute, 2001. All Rights Reserved. 

Developing a network of health services for women from a box full of pieces is a bit like assembling toys on Christmas Eve. There's a chance of disaster or an opportunity to delight. The key to success is collaboration, says Sarah Mulkey.

The administrative director of Women's Health at Hendrick Medical Center, Abilene, Texas, explains that market competition inspired Hendrick leaders to consider instituting a comprehensive network of women's health services. The 445-bed hospital had enjoyed a reputation as the leading healthcare facility in the area for the past three quarters of a century. "But a couple of years ago we realized times were changing. Women were looking for information; they were looking for convenience; they were demanding quality," says Mulkey.

Hendrick already had most of the pieces in place to meet the community's needs. But those services were fragmented into several different areas, and no effective gateway existed for patients to access the services easily. Hospital leaders knew women were a key constituency, and turned their attentions toward Hendrick's once-dominant obstetrics program.

Mulkey, who was hired in 1997 to bolster the flagging OB services, saw that the need went beyond birthing. "I knew we could generate more deliveries, but ultimately the picture needed to be bigger. We needed to look at women's health across the board. I realized that it could be a full service line." That's where Hendrick's "Committed to Women at Every Stage of Life" theme was born. Embraced by the hospital's CEO and backed by a task force of administrators who gave the former director of patient relations a long leash and plenty of support, Mulkey plunged ahead.

Under Mulkey's direction, Hendrick created an informal women's service line, but original plans for a true women's center were more long-range. Initially, Hendrick leaders planned to create a women's center within three to five years, but the construction of a new physicians office building near the main campus opened a fresh opportunity. "There was no commitment for the second floor, which was 25,000 square feet . . . The time was right, the space was available, so we took advantage of that to create the women's center much earlier than we had expected," says Mulkey. She adds that competitive forces within the Abilene market also had a hand in the process.

The facility, which opened in 1998, is known as the "Vera West Women's Center." It was named after retired obstetrics nurse and noted Texan Vera West. West saw the initial plans and the leaders' enthusiasm, and decided to help fund the project. "We had the vision and we knew where we were headed," explains Mulkey, "I truly believe a lot of this came together because the purpose was right."

The results have been so successful, Hendrick has since instituted informal service line structures for cancer, cardiac care, and children=s services. One of the hospital's key service line strategies was to work within the organization's existing management framework. "We didn't blow up the system and start over. We simply continued with all of our managers in place and created a structure that utilized those resources most effectively," says Mulkey. This quiet, casual approach has also avoided some of the pitfalls of service line management such as the silo effect and turf wars.

Although the structure is informal, Mulkey sees herself as a genuine service line director, coordinating the activities of the network and eliminating duplication of services. Mulkey's training as a marriage and family therapist and her experience in patient relations has positioned her well for her current responsibilities. "I was fortunate to have a strong base of trust and collaboration, so it wasn't a difficult leap when I took this job," she says.

Mulkey works with directors of other services to coordinate marketing, patient satisfaction and product development efforts, but does not supervise any of their employees. "I see myself as an orchestra conductor. It's not my job to play the flute or the strings, my job is to know how to coordinate them, bring out the best they have to offer and ensure they play off the same page - our strategic plan."

Mulkey says a willingness among managers and service line directors to share information and work together helps keep the structure strong. "We've all benefited when we have shared events, shared information and shared projects, because it just moved us on to the next level." Hendrick's service line directors have joined forces for a number of community events including "Healthy Heart Day" at Vera West and the center's signature Women's Health Convention, which attracted more than 700 attendees in 1999.

"Women are into relationships, so when you create an environment and a network of services that build on relationships, women respond," Mulkey says. One way Hendrick forms those relationships is through its long-standing membership program, "First Choice." The program gives points for various wellness and prevention procedures such as mammograms, which can be redeemed for small gifts, providing frequent opportunities for cross-marketing.

Women's Health Services now serves as a key gateway to an integrated network of Hendrick programs. Marketing brochures emphasize this role, touting the slogan, "Hendrick Women's Health Network connects you to what's best . . . at every stage of life."

Most operations within this network are performed by the department within which they naturally fall - oncology, rehabilitation, cardiac, for example. One exception is radiology, which includes many services at Vera West but is run by the radiology department. Radiological services include bone density scanning, ultrasound and a newly instituted stereotactic breast biopsy service. Mammography services at both Vera West and "Health Place," a Hendrick mall location where walk-ins are welcome, have been especially popular, hitting a high of 1,214 and 150 respectively during October 1999. The mammography program is supported by a comprehensive breast health program. "Our goal," says Mulkey, "is that every woman who comes in for a diagnostic test will leave with as much information as possible. She won't be told that we'll call her in a few days. Immediate feedback is our ultimate objective."

Mulkey adds that the center's dexascanning services have almost doubled since 1998. The service is backed by a comprehensive osteoporosis program including monthly "Healthy Bones" nutrition classes. Hendrick also features a highly respected cancer center supported by an extensive retail boutique called "Images." While prosthetics are a major component of the facility, Images also offers education programs such as breast self-examination classes.

Of course, the foundation of Hendrick's women's services is its strong obstetrics program. The hospital now delivers nearly 1,400 babies per year, placing it among the top hospitals in the region. Hendrick's OB unit, "The BirthPlace" features four labor, delivery and recovery suites and 23 postpartum rooms. The facility is located in the main hospital, leaving Vera West to function as a dedicated outpatient facility focusing on prevention, education and support. The center also hosts a 'Maternity Fair' each quarter, and two internationally board certified lactation consultants complement the nursing staff. A key component of the women=s health network is the BabyPlace Prenatal Clinic, part of the Hendrick Family Health Center. The clinic provides prenatal care and education to as many as 100 new patients monthly. Through direct assistance from social workers at the clinic, 98% of Medicaid-eligible patients acquire coverage. In addition, the Family Health Center provides family planning and gynecological services to more than 10,000 underserved women in the region.

Four OB/GYN specialists also keep offices at Vera West. While the women's center shares a significant amount of common area with the physicians, their practices remain independent. "We really like the layout and I think doctors also appreciate it, since it doesn't keep them confined to a certain amount of waiting space," says Mulkey. Physicians enjoy the convenience of referring their patients to the Resource Center for video education on routine procedures like epidural anesthesia, laparoscopy, and hysterectomy.

The "Mommy Market" is a full-service retail boutique store situated in a high-traffic area of Vera West. Although it focuses primarily on lactation support services, the manager boasts extensive retail experience and frequently interacts with patients in the waiting area. The women's resource center, located in an open area near the entrance to Vera West, features a lending library, audio and television equipment for patient education, Internet access and full-time staffing.

Education, says Mulkey, is a key objective of women's services. "Our theme, "Committed to Women at Every Stage of Life" is very broad, so we really attempt to personalize the concept," she explains. Recognizing women's unique needs at different stages in their lives, the women's center has instituted a number of education programs focusing on very specific issues loosely based upon another of the service line's themes, "awakening, nurturing, sharing and realizing."

For teens and pre-teens, the center offers "Developing Bodies" classes. Women who may be contemplating or starting a family are offered "Nurturing" classes, and other programs, such as osteoporosis screening and education, are aimed at midlife and senior women to help them get the most out of these life stages. Mulkey predicts an increase in programs for older populations, such as arthritis support groups and education. "It's an area that's clamoring for attention," she says.

A truly unique program, "Women of the West@ Tell Their Stories, will even be incorporated into local Women's History Month celebration this March. Provided with a study sheet and guide posing key questions, the program encourages women to write their own life stories. Mulkey notes that "Women of the West . . ." may soon be expanded to local schools. Another cutting-edge program, call "Lunch Money," helps women manage their finances more effectively. "While this may not be a clinical or physical issue," says Mulkey, "it definitely impacts women's self esteem, which can affect their health."

Vera West also features a strong sports medicine component in collaboration with Hendrick Center for Rehabilitation. The rehab program features exercise and education covering everything from stress- and pain-management to incontinence and lymphedema. "We've really brought a market to rehab, and we've worked very closely to get our physicians educated about what's available."

Key Services offered by Vera West and the Hendrick Women's Health Network

Future plans call for more emphasis on alternative therapies such as massage. "I think, for us, the next change coming in women's health will be in complementary medicine," says Mulkey. "We're sticking our toe in right now, but women are asking for that, and I think soon they will be demanding it."

Mulkey notes that much of the service line's product development happens intuitively, but many of the ideas for new programs or improvements to existing ones also spring from Hendrick's active Women's Health Council. Composed of 12 women representing different stages of life, and various ethnic groups and professional statuses, the council acts as a mouthpiece for the community, says Mulkey. "They give us information about what they perceive as the community's needs and we provide them information about what we are doing. They are wonderful marketers for the network."

Her advice to other hospitals hoping to build a comprehensive, collaborative women's health network using existing materials? The first priority, she says, is to develop interaction skills that allow you to gain the trust and cooperation of managers and other service line directors in a non-threatening way. Second, ensure your facility has a strong physical presence in the community through comprehensive education programs and perhaps a mall-based facility. And third, create an interesting retail arm that adds value to the service line by drawing patients and customers back to your facility.

Mulkey sees her position as an informal service line director as a sort of "Johnny Appleseed" of the hospital, helping the facility pull together existing resources to meet new needs as they arise. "It's the thing I love to do - to take something I see could be different, better, and implement changes to help make the vision a reality," she says.

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Richard Ireland is presdent of The Ireland Corporation/The Snowmass Institute, Centennial, Colorado. He may be reached at snowinst@eazy.net.
From The Ireland Report on Succeeding in Women's Health, January/February 2000.

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8 The Ireland Corporation/The Snowmass Institute, 2001. All Rights Reserved.
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