Thursday, December 22, 2011

Closing the Book on 2011

As 2011 draws to a close, it's appropriate to reflect on the past year.

In many ways, Santa has been very good to GRMC. We have welcomed many new employees and medical staff members.

We are fully staffed in our internal medicine department with the additions of Drs. Ron Collins and Todd Janicki, who join Dr. Chris Lindgren. This is a magnificient team who will serve the adult medicine needs of the communities we serve for years to come.

Last December, we welcomed Dr. Steven Ellestad to our emergency department. At that same time, we also welcomed Dr. Seanna Thompson as our first OB/GYN specialist. As they each finish their first year here, it is clear that they have distinguished themselves as excellent additions to the GRMC team.

Dr. Soraya Rodriquez rounded out the physician newcomers this year, bringing new levels of service and expertise to the laboratory as our resident pathologist.

Nurse anesthetist Troy Anderson joined his wife Alexzandra (now full time), and Dr. Emge in our anesthesia department in late 2010. We are blessed to have such a caring and expert team serving our anesthesia needs.

Jill Jensen, physician assistant, also joined our team this year. She leads our employee health and corporate wellness efforts. She is also filling in throughout our system during various leaves.

This year is also proving to be one of the best years for the annual fund drive - again showing us how much the community supports the important work of GRMC. The annual fund has raised more than $350,000 to date for operating and capital needs. The annual fund is absolutely vital to GRMC.

From these funds, we have purchased two of four needed anesthesia units for the surgery department, and funds are still coming in to purchase the remaining two. The first two units arrived last week to the delight of our anesthesia providers! In addition, this week we were able to order a much-needed new van for our mobile services unit thanks to gifts dedicated to that service.

The annual fund allows us to distribute 550 bicycle helmets to all third graders in the GRMC service area. Each helmet is specially-fitted for every child.

The Community Care Clinic provided more than 375 patient visits this past year, thanks to gifts made to the annual fund.

We had a great party in September at the Grinnell Municipal Airport with more than 300 guests dancing to the tunes of The Dweebs. Our first Blue Jean Ball raised about $16,000 to support surgical needs.

And back in the beginning of 2011, we installed our first fixed-based MRI in our radiology department. No more going outside in the Iowa winter for an MRI anymore, thanks to more than $300,000 in donations from the community.

As you know, not everything is merry and bright. We continue to face financial challenges. You have heard about our poor Medicare and Medicaid payments. Our challenges are big, but they are not desperate. There are many things to look forward to in 2012.

In January, GRMC will see a significant increase in our Medicare payment rates through a Centers for Medicare and Medicaid Rural Community Hospital Demonstration Program. The purpose of the project is to see how rural middle-sized hospitals would fare if they were only reimbursed for their costs when caring for Medicare patients when they are hospitalized. While this covers inpatient care only, it is a welcome increase when GRMC has been reimbursed far below our costs to provide care.

We teamed up with Surgical Associates to bring another new general surgeon to Grinnell - Mathew Severidt, DO will come to our community in July 2012.

We are finalizing an agreement for a new orthopedic surgeon to also join us in the summer.

We have a new nurse practitioner, Jessie Collum, joining Deer Creek Health Center in February.

Gifts from two donors have provided us with funding to finish remodeling the first floor hallway and replace flooring in the cafeteria.

I could go on. The point is, despite difficult times, the staff and volunteers at GRMC continue to work together for the benefit of the people we serve. Good things are happening. The care we deliver is of high quality and efficiently provided. We are proud of our collective efforts to fulfill the vital mission and promise to the people we serve.

Our future depends on many things, but mostly on us, the dedicated and talented women and men who make up our team - supported by an expert and caring medical staff, committed board and foundation board, extraordinary auxiliary, and a very supportive community. We will indeed overcome our financial challenges and continue to be one of the best rural hospitals anywhere.

As the year draws to a close, let me wish all of you a very Merry Christmas, and a healthy and happy New Year!

From all of us at GRMC...

From all of us at GRMC...

Happy Holidays, Merry Christmas, and all the best for 2012!

Thursday, November 17, 2011

The Washington Post is on the line, Todd...

It's not every day that a reporter from The Washington Post gives me a call.

A good friend of mine, Sita Ananth, director of knowledge services at the Samueli Institute, was first called by Post reporter, Michelle Andrews. The focus of the article is about how hospitals are using integrated therapies, such as massage and acupuncture. A topic we are very familiar with at GRMC.

In fact, this is not the first time GRMC has had national media coverage for our integrated medicine program. Nearly three years ago, a USA Today reporter came to Grinnell and did a story (read it here) on the positive effects of integrated therapies and featured Anne Stephens, MSOM, LAc and the Acupuncture Clinic of Grinnell. Anne's clinic is located at GRMC's Postels Community Health Park.

This week's Post article * also talks about why hospitals are moving toward more of these therapies. At GRMC we use integrated health to help improve patient outcomes. For example, a preoperative chair massage helps patients reduce anxiety and their IV's start easier and they use less pain medicine after surgery. To me, it is also about helping people stay well in the first place so that if people do require medical care, maybe they won't need the degree of care they might otherwise need if they weren't as healthy to begin with.

I know. That seems contrary to the message you'd expect to hear from the CEO of a hospital, especially when we are all trying to find new ways to generate revenue. However, community hospitals that aren't in the wellness and health improvement business will soon wish they were as we shift from the current fee-for-service reimbursement system to one of being at risk for the health of a population.

We have been engaged in integrated health for more than a decade at GRMC. In this search for finding the best ways to improve health, we are not alone. Some of the most prestigious healthcare institutions in the country also have robust integrative therapy programs like the Mayo Clinic, Kaiser, and the Cleveland Clinic...all world-renowned, highly respected healthcare institutions.

I am glad that the Samueli Institute, who does a comprehensive nationwide survey of complementary and alternative medicine, along with the American Hospital Association/Health Forum, encouraged The Washington Post to "call Grinnell Regional Medical Center about this topic." It is fun to share with America and beyond what our team is doing so well here in Grinnell.

Across the board, to matter the specialty, I am proud of ever single provider, employee, volunteer, and supporter who make GRMC the extraordinary community hospital it is.

* please note, to access The Washington Post article you may have to register. There is no fee to do so.

Thursday, November 3, 2011

Buckle your seatbelts, it's going to be a bumpy ride

Oh, boy...hang on to your hats!
It looks like it is going to be a bumpy ride for healthcare providers as the federal government wrestles with the deficit. President Obama recently released his recommendations for reductions over the next ten years and compared to MedPAC (the advisory board to Congress on Medicare issues) and the Congressional Budget Office, the President's proposal is the most moderate. But that said, he is still recommending a cut of $320 billion on top of the $155 billion that was already part of the Affordable Care Act. Ouch! This would mean massive reductions in staff and services in the nation's hospitals as a result.
There is no question that if you are going to make a meaningful reduction in the federal deficit you are probably going to have to look at Medicare and Medicaid since they make up such a big part of the deficit. At the same time, when the economy continues to be on the rocks, these cuts will most certainly mean big reductions in jobs in the healthcare sector. This is going to be a tough decision for lawmakers and given the unbelievable partisanship going on in Washington right now, I really don't think an agreement is likely.
Are there any other answers to reducing the costs in Medicare and Medicaid in this country? Sure. There were several huge disappointments in the Affordable Care Act including a total lack of personal responsibility for people to take care of themselves. There is a lot of money in the law for improving health, but little incentive for individuals to be accountable for their own health. Think about it - the law really starts shifting the financial responsibility for improved health to the providers. One of the centerpieces of the law is the Value Based Purchasing (VBP) which incents providers to improve care and reduce costs for Medicare beneficiaries by holding back some of the payment at the front end and letting hospitals compete on improved quality and patient satisfaction scores. The quality measures are moving toward looking at outcomes for Medicare patients and will reward those providers with the best outcomes.
I fully support the government buying healthcare based on value. We actually expect that Iowa providers will do very well with this provision of the law given our high quality scores and lower expenses compared to other parts of the country. However, why not also incent the beneficiaries to be partners in their health? The physician can provide all the right advice to his or her diabetic or hypertensive patients, but if they won't improve their diet or take their medication, the provider gets punished by the system and ultimately there will be no cost savings.
I just got back from Mississippi where the obesity rate is the highest in the country. No offense, but folks there appear to really like their fried food. While I was there, I heard a local doctor on a panel of presenters. He did some of his training in Colorado where they have the lowest obesity rates. He said many Colorado residents like to hike in the mountains and eat granola. It is a concern if Mississippi doctors are going to be evaluated then punished for how well their patients control their diabetes compared to his medical counterparts in Colorado. Shouldn't the patient take some responsibility to be compliant and accountable for their health and the recommendations their doctor makes?
I realize it is going to be extremely difficult for a politician to stand up in front of voters and say, "I am going to work on legislation that will likely have an impact on the lifestyle choices people are making."
The largest and fastest growing part of the federal budget is related to Medicare and Medicaid. I believe it is time for us all to realize that if through taxes we are going to pay for the care of seniors and the poor, we will never afford it if beneficiaries are not required to take some responsibility for living a healthy lifestyle.
In the meantime, if the federal budget is going to be balanced by slashing reimbursements to hospitals and physicians for providing Medicare and Medicaid to a growing population and one that seems to be less healthy, I do believe we are indeed headed for a very bumpy ride.

Monday, October 24, 2011

A Spook-tacular Halloween Ride

Spinning® is one of the most popular group wellness classes offered through Grinnell Regional Wellness and Fitness Center. This indoor cycling program is led by a certified Spinning® instructor who takes participants through a workout that simulates an outdoor ride.

Like many fitness classes, music is a very important part of the experience.

In fact, research has shown that the right music can help athletes lower their perception of effort making the brain think that the body is not working as hard as it really is. Music used in connection with exercise can help set the pace for moving to the beat of the music.

Spinning® instructors also become a disc-jockey because they carefully select music for the warm-up, the various components of the ride, and the cool-down. One of GRMC’s Spinning® instructors, Denise Lamphier, submitted a playlist for a spooky Halloween ride to the Spinning® instructors’ newsletter for a contest. Denise’s playlist was one of three selected to be featured from instructors’ submissions from all over the country. Congratulations, Denise!

You can join Denise on her Halloween Spinning® ride at 5:30 a.m., Monday, October 31. It’s early, but don’t let that scare you! Join in the fun and get your Halloween Monday off to a fun and fit start.

This will be the first-ever Spinning® class in the new fitness center location at Postels Community Health Park on the Commercial Street entrance. GRMC is thrilled to develop the space at Postels to bring even more of our wellness services under one roof. Come and check out the new digs!

Questions? Call Cory Jackson, wellness director, 641-236-2999.

Playlist by Denise Lamphier:
“This Is Halloween” Marilyn Manson
“Monster Mash” Bobby "Boris" Pickett
“Ghostbusters” Ray Parker Jr.
“Bat Out of Hell” Meatloaf
“I Want Candy (Kevin Shields Remix)” Bow Wow Wow
“Hotel California” The Eagles
“Twilight Zone” Golden Earring
“Millie and Billie” Alice Cooper
“Marie Lavaux” Bobby Bare
“Little Red Riding Hood” Nine Nine Nine
“Ben” Michael Jackson

Wednesday, October 19, 2011

Influencing Rural Healthcare Policy with NACRHHS

I just attended my last meeting as a member of the National Advisory Committee for Rural Health and Human Services. This committee is made up of men and women from all across our nation from Alaska to Maine, Florida to Montana. Members include doctors, nurse practitioners, academics, politicians, Medicare officials, association leaders and hospital administrators. The committee is well-supported by staff from the Office of Rural Health Policy. Our primary responsibility is to advise the Secretary of Health and Human Services on rural policy issues. It has been a privilege to serve with these fine folks. They take this job seriously and we get into some very healthy debates about what is best for the people of rural America.

Twice a year, the committee takes a field trip and this most recent meeting was held in Hattiesburg, Mississippi, hosted by our committee chair and former Governor of Mississippi, Ronnie Musgrove.

My subcommittee was charged to make recommendations to Secretary Sibelius about the new primary care payment changes for physicians and other healthcare providers. The proposed rule for this provision in the Affordable Care Act was just published in July and my sense is that most providers don't know much about it. One of our recommendations will likely be that HHS needs to gets more information so providers can prepare for these upcoming changes. Much like value based payment (VBP) for hospitals, this provision in the law will reward providers that enhance quality and reduce resource use for Medicare patients in their practices. Although this idea has been trialed in a number of practices around the country, it was not tested in rural communities.

We will likely be completing our briefing paper to the Secretary in the next several weeks. There is additional information at the NACRHHS website. Also on this website are other reports and briefing papers the committee has completed, including the most recent on the demonstration project on VBP for smaller hospitals, insurance exchanges, and aging.

I will miss these meetings for two major reasons. I will miss the truly wonderful people who serve on and supoprt the committee and also the opportunity to have input into the executive branch of government. I believe this committee has helped to address concerns and issues that impact people in rural America. I send all my best wishes to the committee as a new group of members join those who continue their terms of service.

Thursday, October 13, 2011

Falling From the Sky

Leading a healthcare organization these days often feels like I'm falling out of the sky...

What will be the future of healthcare reform?
How viable will rural hospitals be?
Will there be the resources necessary to keep facilities and equipment up to the standards of quality we demand?

To mark my son Grant's 18th birthday and to check an item off my bucket list, we went skydiving. What a rush! Sky Dive Iowa is located about ten minutes from my home in Brooklyn, Iowa, and on a beautiful August Sunday morning in Iowa, we jumped out of a perfectly good airplane for the first time.

We did a tandem jump and each of us were strapped to an experienced diver. I was with a diver who was a paratrooper just back from Afghanistan. He was friendly with loads of confidence and focus. I felt safe the entire time. Grant and I received about 15 minutes of instruction and then we boarded the plane with the divers, the pilot, and a videographer. It took about 20 minutes for the plane to take us up to about 8,000 feet.

Then, the moment of truth...time to jump! It was pure heart-thumping and adrenaline-pumping exhiliaration as we fell through the sky for a 20-second free fall before the diver pulled the cord on the parachute. We slowly floated and peacefully decended. Grant and his diver jumped out behind us and the divers guided us to within feet of each other. It was amazing to see Grant floating alongside as we both slowly fell to earth. The whole thing probably took about 10 minutes. The landing was a piece of cake and soon Grant and I were arm-in-arm with smiles as big as a Texas ranch. "Awesome" was the word we kept using over and over again.

So, how did my free fall compare to the tumultous times in healthcare these days? Honestly, skydiving is a piece of cake compared to running a hospital these days. I definitely recommend a sky dive for anyone who is a little adventurous.... you will be glad you did.

Friday, October 7, 2011

Do good for yourself and others. "It's the BEAUTY SCHOOL rule."

Women of the GRMC service area took home this message of taking care of themselves following the

fifth Women’s Health Focus and Baby Fair.

Six ladies showcased their makeovers and many women had their hair styled as part of the many special activities of the evening. Above is a before and after photo of Mary, a GRMC employee.

GRMC Massage therapists provided chair massages and chair yoga.

Thursday, September 15, 2011

Hurricane Irene: Up Close and Personal

My girlfriend Angela and I decided to take a long weekend trip to New York City. Angela had not been to the Big Apple before and we were looking forward to a short getaway. After a long storm delay, we finally arrived in NYC around midnight. It was an omen.
Our plan was to fly home on Sunday evening after taking in a Broadway show and a tour of the city, but that was not to be.
On Friday, the forecast tracked a direct hit to NYC from Hurricane Irene.
On advice from the hotel, we headed to the closest Rite-Aid for supplies in the chance that the city was without power for a few days. Bottled water, peanut butter, granola bars, chips and salsa seemed to make the most sense to us, a couple of Iowans in the path of a hurricane. Times Square is always crazy, but we were joined by what seemed like thousands of others also wondering how to prepare for the pending storm. The shelves were soon bare.
New York is often called "the city that never sleeps." But sleep it did by noon on Saturday when it actually shut down. It was historic! About five hospitals in low lying areas actually evacuated their patients and others put their disaster preparedness plans into action. Shops and restaurants closed. All public transit shut down and the Mayor asked everyone to prepare for the worst and hope for the best.
Fortunately, the best happened and although the storm did create havoc along the Eastern Seaboard, New York City was spared and damage was minimal. All we really experienced was some strong winds and a lot of rain. By Sunday afternoon, the sun actually peeked out and the city came back to life.
When I'm in NYC, folks often ask where I am from and it's great fun to tell them I am from Brooklyn. They say, "That's funny, you don't sound like you're from Brooklyn..." When I tell them the Brooklyn I am from is in Iowa and has 1,500 residents instead of 1.5 million residents, they always get a big smile.

As you might have guessed, our Sunday flight was cancelled and we could not get a flight out until Tuesday. Because of something to do with the hurricane, The David Letterman Show needed an audience on Monday. This was a Bucket List item for both of us, so we were thrilled to score free tickets! It was really fun to see all the behind the scenes things that go on to produce a show like that every weeknight. We agree with Alan Colter, the Late Show announcer that New York City is indeed "the greatest city in the world!"

Wednesday, September 7, 2011

“Untangle Life” at GRMC Women’s Health Focus and Baby Fair

Guest Blog
Jeanette Budding, Assistant Director
GRMC Communications and Development
It’s easy for anyone to get tangled up in the busyness of life that we can forget to take care of ourselves as we are trying to take care of everyone and everything else in our lives.

But for one night out of the year, women can take time to untangle and enjoy laughing together. Join more than 500 women at the Women’s Health Focus and Baby Fair. In its fifth year, this GRMC event focuses on women – a fun and educational night out with friends. And, this year will be no exception. The theme, “You: Untangled,” is all about letting our hair down, having fun, working out the tangles of life’s stresses, and learning something about ourselves and our inner beauty.

Our keynote speaker, Pat Wynn Brown, will provide a humorous performance about our love-hate relationship with our hair. She says that her Hair Theater Beauty School is a laughter and story-telling ‘conditioner’ for the tangles of life’s stresses and frets. Humor is an age-defier and a good giggle can erase years off our face. The phases of our hair and lives share a common message for all women. Pat’s message will touch each of our lives.

Young women, new and expecting mothers, as well as grandmothers will find the latest information on pregnancy and babies. Plus, we have excellent door prizes and drawings for those who sign up, like a handmade baby quilt, car seats, and more.

This year we have a new activity related to our theme and speaker – makeovers for six lucky women who purchase their tickets by Sept. 21. Winners will have their makeover during the day prior to our event. We also have local salons who will offer 10-minute hair “up-dos.” These are just quick styles for the evening.

Make plans to join us on Wednesday, October 5, at the Grinnell Newburg High School.

The evening will begin at 4 p.m. with 40 educational booths, retail therapy vendors including The Glass Gift Box and area hair stylists.

Once again, a fabulous buffet meal will be catered by the Mayflower Community with salads, pasta dishes, and incredible desserts.

And we’ve thought of everything, even childcare on site and dinner provided for the little ones over 2, all for $3 per child.

Tickets to the event are $18 and financial assistance is available. Register for childcare at the time of ticket purchase. To purchase tickets, go online here. Tickets are also available at The Glass Gift Box located inside GRMC, Dori’s Fine Fashion and Shoes, and Postels Community Health Park.

Friday, August 19, 2011

GRMC Hosts First-Ever Blue Jean Ball

Guest post by Laura Nelson-Lof, GRMC marketing specialist

The Blue Jean Ball Caps a Great Day At the Grinnell Regional Airport
Come to the Optimists Fly-In Breakfast with the family in the morning and come back in the evening for some grown up fun...

Get out your favorite jeans and make plans now to attend the first-ever GRMC Blue Jean Ball on Saturday, September 24, 8 to midnight at Grinnell Regional Airport/Billy Robinson Field.

The event has a little something for everyone. For tickets to this fun celebration of the great relationship between GRMC and the community, you may go here or any of the following locations:
Grinnell: The Glass Gift Box at GRMC, Postels Community Health Park
Brooklyn: Seaton's Grocery
Lynnville: Lynnville Medical Clinic
Montezuma: Montezuma State Bank, Peoples Savings Bank
New Sharon: New Sharon Memorial Clinic
Tama/Toledo: Deer Creek Health Center
Victor: Victor Health Clinic and Victor Market

Tickets are $25 each, two for $45 in advance. $30 each at the door.

Headlining the evening's entertainment are The Dweebs, a popular Wisconsin-based cover band that plays hits from the 70's to today. Check them out here!

Ben Latimer and Dr. Jeff Knobloch are the masters of ceremonies for the evening that will include celebrating Todd Linden's upcoming 50th birthday.

An incredible array of items are on offer for guests to bid on through a silent auction, live auction, and raffle. You can read the list of great items here.

Silent auction items include handmade truffles, framed artworks by local artists, a ride along with Grinnell's finest - the Grinnell Police Department, overnight stays at area bed and breakfasts, gift baskets, exquisite California wines, and more.

Live auction items feature week-long stays in an Estes Park, Colorado condo or a week at a luxury highrise condo in downtown Chicago on Lake Shore Drive.

The raffle offers the change to win an iPad2 or a Flip camera. Something for everyone.

Proceeds from the event will go to support equipment needs in the surgery department at GRMC. For more information, please call 641-236-2954.

Friday, August 5, 2011

Doctors for Adults

I am thrilled that with the addition of Todd Janicki, MD, MBA, on July 1, Grinnell Regional Internal Medicine now accepts referrals for advance adult care. The team of Todd Janicki, Christine Lindgren MD, PhD, and Ronald Collins, Jr., MD, is an excellent one. As I have written before, physician recruitment for a rural community hospital can be challenging. These physicians have years of experience in diagnosing and treating challenging cases. They're not straight out of residency. We specifically recruited for strong clinical backgrounds for these important positions.
We also recruited for those physicians who enjoy practicing in a smaller community with all it has to offer. Physicians who would prefer to be anonymous in their community would probably not fare well in a rural setting where everyone knows (or is related to) everyone else. And we believe that the quality of life in our area is exceptional. Not everyone, though, is drawn to a rural community but thrives in the bustle of urban or suburban life.
This team of physicians expands the spectrum of specialty care that we can provide right here at GRMC. This practice is really a hybrid with an emphasis on hospitalist activity. Each of these three physicians rotates their clinic hours and provides inpatient coverage. For some patients, the internist directs patient care during hospitalization. For outpatient care, patients need a referral from their primary care provider or surgeon and may also be referred to the clinic following hospitalization.
You and your physician can determine if you have a medical condition that would benefit from a consult with these specialists at Grinnell Regional Internal Medicine. It's great to have these physicians on our medical staff.

Friday, July 15, 2011

Did you know GRMC offers childbirth classes?

Guest post by Ashley Grundler, graphic designer, GRMC

My husband, Chris, and I have been attending weekly childbirth classes through GRMC. The two-hour classes run for four weeks on Tuesday evenings. These classes seem to be a bit of a hidden gem and I'm here to tell you, they are a must for any first-time parents.

So far we've attended two classes that have touched on everything from discomforts of pregnancy to what to expect during labor and delivery. And can I just say, I have learned so much!

Kim Jones, RN, is an experienced OB nurse and she has carefully walked us through breathing techniques, showed us equipment we shouldn't be startled to see during delivery, and truly prepared us for what to expect once we arrive at the hospital.

I urge all expecting moms and dads to attend this wonderful and informative four-week class. I already feel less anxious about childbirth and my husband feels more comfortable in his role as my labor support person.

It won't be long now before our daughter is born. These classes answer questions we didn't know we had and have eased a lot of our fears. Our doctors and the staff at GRMC have been with us every step of this journey. We are enjoying these last weeks of pregnancy and are looking forward to welcoming our daughter soon!

Friday, July 1, 2011

Please, don't hurt the ones you love...

The current national debate over the federal budget and debt limits/debt reduction could have a severe impact to hospitals and healthcare centers across the country. Some in Congress are considering a $100 billion cut in Medicare and Medicaid reimbursements to hospitals. These funding programs exist to care for persons with disabilities, seniors, children, and the most poor in our nation.

Most people know the financial challenges that Grinnell Regional Medical Center has faced because of already low reimbursement from Medicare and Medicaid. More than half of our patients rely on these programs for their primary health insurance. Cuts in these programs affect all of us, whether we use them ourselves or not.

All over the country, hospitals just like GRMC are open 24/7 and stand ready as the only source of medical care for millions of Americans. Please, join me in telling Congress to protect hospital care.

To learn more, go to

Monday, June 20, 2011

Another measure of quality healthcare

The following is a guest blog, written by Janet Lacey, director of patient experience at GRMC.

"Our way to create and enhance a service excellence journey to build patient loyalty, foster teamwork, and celebrate the joy of caring."

The phrase above sums up our Compassion in Action service initiative program. We recognize employees and volunteers as they are "Caught In The Act" of providing exceptional service, of going above and beyond what's expected. We have been following this and other paths for years to provide patients with quality healthcare, and an outstanding experience, all at a good value.

For the next several weeks, GRMC employees will participate in short, effective 30-minute meetings called "huddles." These sessions are just like football huddles: short, to the point, and unite us as a team.

Quality huddles contain information for GRMC employees that explains a new program from the Centers for Medicare and Medicaid Services called Value Based Purchasing. VBP as it is known, is an initiative required by the Patient Protection and Affordable Care Act. Through the VBP, CMS will withhold one percent of hospitals' Medicare inpatient payments as an incentive for meeting quality measures. Hospitals can earn back part of that withheld payment by how well we meet certain standards of quality.

This program starts on July 1, 2011, just a couple of weeks away. But, at GRMC, the focus has always been on quality healthcare. The incentive payments are definitely important, but we focus on quality for one major reason. We want to keep our patients as safe and well cared for as we possibly can. After all, we are caring for each other's friends, family, and neighbors.

Over the next few weeks, all employees will participate in a huddle to learn more about the program and how important every single staff member is to this process. The huddles will explain how the safety and satisfaction of our patients, HCAHPS survey scores, Core Measures, and Value Based Purchasing all interact, what they mean, and how we can use them to improve the quality of care delivered at GRMC.

Thursday, June 9, 2011

Walking In the Shoes of the Revenue Cycle Team

Recently, I had the pleasure of walking in the shoes of another great GRMC department, the revenue cycle team. This department includes admitting, coding, and patient accounting. A "walk in the shoes" is like a job shadowing experience and I learn new things about the various functions that employees do everyday to make this hospital run smoothly.

What a very busy and complex world the revenue cycle team lives in each day!

Let's walk through it from a patient's perspective:
It all begins with a physician order for the patient to get care from the hospital. When the patient arrives, they are greeted by our resource nurse and/or our volunteer. If they need their car parked or have a question with the order, the resource nurse is there to help. The volunteer helps organize the patient's trip through the process and often escorts them exactly where they need to go.

The admitting clerk goes through a very detailed process of making sure we have all the necessary information so the patient receives the care or service they came to the hospital for and so the hospital can appropriately bill for those services.

The patient receives an identification wristband and then they move on for testing, a procedure, treatment, or whatever brings them to GRMC that day.

What happens behind the scene is vitally important for the patient, even though they may never meet these staff members. After the service is provided to the patient, a record is established and sent to the coding team. Their job is to convert the record of the care the patient received into one of what seems like a zillion codes to be submitted on a bill to Medicare, Medicaid, or a private insurance company. This is very detailed work.

The coded description of the care the patient received at the hospital is sent to our staff members who create and submit the bill to the insurance company, Medicare, or Medicaid for payment.

When the hospital receives payment from the insurance company or from Medicare or Medicaid, it is time to create and submit a bill to the patient if needed. At GRMC, we have outsourced this activity to a third-party billing company and information is submitted to them to create a bill for the patient.

We also have cashiers who interact with patients directly that might not have insurance. The cashiers receive payments or help patients set up a payment plan.

Bottom line: these employees have challenging jobs because the details frequently change and the work can be very complicated. I was impressed with the cross training that employees have and the team environment that has been created. They work hard to balance great customer service with the need to be sure we are safeguarding the financial health of the medical center.

Also located in this area is the hospital operator. That is another job that can be really hectic at times with the number and variety of calls that come to GRMC.

Everyone on this team is dedicated to great patient care and to the mission of GRMC. Thanks for all you do!

Friday, May 20, 2011

Creating Coherent Caring Environments

The focus of the first HeartMath Best Practices Conference is how to create the kind of healthcare environment that transforms lives of caregivers and patients alike.

Robert Browning is the director of project development for HeartMath. He led us through an exercise around caring with another person that can be used in any setting, but particularly in patient care.

This is another example of how this is a different kind of conference. We are not only hearing presentations and getting great ideas, we are also experiencing and participating. Conference attendees have the option of starting the day with "Morning Renewal: Running with Qi." The setting for this conference also lends itself to renewal and greater coherence. The beauty of the California coastline is remarkable. In some ways, this is as much a retreat as a conference.

Healthcare organizations of all sizes are using HeartMath. Yesterday, I wrote about the Mayo Clinic and HeartMath. Like Mayo, Kaiser Permanente is widely recognized around the country as one of the leaders in patient care quality and experience. Anne Foss-Durant is a director of caring services integration for Kaiser and shared her work while she was the Chief Nursing Officer for Kaiser in Antioch, CA. Many healthcare organizations are adopting Jean Watson's work on caring theory and integrating it with HeartMath. The results of this approach from Antioch were remarkable. In the last two JCAHO inspections, there were zero deficiencies listed. In fact, when the inspection team arrived, Kaiser staff invited the team to join them in a Heart Lock-In to start the survey process. Now that is coherence in action!

Another highlight of Anne's presentation was her statement that the level of trust between nursing and administration improved because caring sciences and HeartMath fostered the practice of staff truly caring for themselves which in turn nurtured caring for the patient. Anne remarked that it really put joy into patient care.

Eric Faller, Jeremy Hagar, and Toni Carreon represented Kaiser Permanente in Fresno, CA. Because of the success that Anne and her team had with HeartMath at Kaiser in Antioch, the administration decided to expand HeartMath and caring sciences to all of their regional hospitals. These representatives provided several stories of innovation and engagement by their teams. Ultimately, they said the benchmarking data for patient quality became a byproduct of genuine care for patients.

Chesapeake Regional Medical Center did a great job providing tips on how healthcare facilities can utilize several standard training programs in a consolidated approach. For example, they merged HeartMath with Jean Watson's Caritas program that best serves their organization. Again, creating a better environment for staff facilitates better care for patients from clinical staff.

There are so many models for excellent patient care that tie in beautifully with HeartMath. Another approach was presented by Memorial Hospital in South Bend, Indiana. Memorial began integrating HeartMath into their leadership development program in the mid-1990's. George Soper, Barbara Walsh, and Deborah Drendall explained how the fundamental HeartMath concept of coherence was really the foundation for effective performance. It was an impressive presentation of how they used Stephen Covey's Seven Habits of Highly Successful People as the framework for their leadership development along with HeartMath. It all fit together with assessments, teamwork, discipline, and accountability as a most effective process.

Two teaching hospitals, University of Oklahoma College of Nursing and Indiana University Health of Bloomington presented incredible information on how they have used HeartMath.

At the University of Oklahoma, HeartMath has helped to create high level performance and cultural empathy from the student to the expert. They outlined a way to create an environment that looks at traditional native healing, holistic healing, and energy work.

Indiana University Health of Bloomington presented on how to integrate the HeartMath program into relationship-based care as the core of self-care, patient care applications, and pain management. IUH outlined ways to create a culture that keeps HeartMath tools and techniques in front of every employee. They also reported on ways they use HeartMath with occupational health and employee wellness to help lower costs and reduce insurance claims.

The conference concluded with roundtable discussions, dinner, and a bonfire on the beach....a perfect close to a wonderful day of learning, sharing, caring, and interacting.

A different kind of conference

As noted in my previous post, I am blogging this week from the HeartMath Best Practices Conference and it is a wonderful experience.

Mayo Clinic Arizona staff, Susan Launder, Barbra Hudak, and Lynne Hulvey shared how they have transformed the culture in their nursing unit by infusing HeartMath into the daily activities of their team. Susan is the team leader and she says, "When the staff is happy...everyone's happy and HeartMath bring happiness!"

Lynne is a SWAT nurse. This means that she is a critical care nurse who is available to respond quickly when a patient's medical condition rapidly deteriorates or when the nursing workload is becoming overwhelming. Barbra is the house supervisor. Those of us who participated in their presentations could not help but be impressed by the passion these nurses have for their teams and in turn the care they provide to their patients. Their presentation focused on how other hospitals can work to expand HeartMath to transform the culture of their entire hospital. In their case, they reported to the Mayo Board of Governors their experiences with HeartMath on their unit and how they felt HeartMath would be beneficial to the entire Mayo Clinic Arizona system.

The data they provided was striking. Since initiating HeartMath, error rates on their unit improved. Better communication, clearer critical thinking, and improved working relationships all contributed to overall improvement. As a result, the Board of Governors agreed and HeartMath was expanded throughout the Mayo Clinic Arizona System.

Personally, I know HeartMath changes lives. I've seen this many times in my own experiences. I think it is very powerful to also see the data that HeartMath also saves lives through improved patient safety.

As we finished the day, we were encouraged to consider what we appreciated most from the day... Appreciation is a big part of HeartMath...I found several things to appreciate.

  • Lots of great ideas from very inspired leaders.

  • Genuine compassion, caring, and passion.

  • Profound organizational commitment.

  • Stories that spread positive, good news to others.

  • The connection between Qigong and HeartMath - to move and breathe with life

  • Evidenced-based science adds creditability and opportunity for improved patient care.

  • HeartMath changes and saves lives.

This is a different kind of conference...the pace is deliberate, content-focused, and thoughtful. I can hardly wait to see what's next.

Wednesday, May 18, 2011

I am so excited to be blogging from the HeartMath Best Practices Conference: Creating Coherent Caring Environments.

I have to admit, I’m a little travel weary. I actually flew from New York City this morning on a 6 a.m. flight, but the beautiful location here at the Seascape Beach Resort in Santa Cruz, California is reviving me. And, I got in on the last two presentations for the morning.

The conference is off to a great start. HeartMath CEO Bruce Cryer welcomed us to this first-ever best practices conference. Presenters from Fairfield Medical Center of Lancaster, Ohio, and Scottsdale Healthcare in Scottsdale, Arizona followed Bruce and they were great.

I first met presenter Cynthia Pearsall, chief nursing office from Fairfield Medical Center, when my team and I went through our first training session several years ago. It was really fun to see her again today and hear about their journey at Fairfield with HeartMath. Their presentation was all about integrating HeartMath into a hospital culture and it was inspirational to hear about all the lives that are being touched by HeartMath.

The Fairfield team followed their presentation with a wonderful video featuring seven staffers sharing their personal stories with HeartMath. One woman shared how it helps her and her husband deal with the hectic life of parents of six children. Another employee shared how HeartMath changed her life after a horrible traffic accident that she lived through as a teenager. The accident created lifelong anxiety whenever driving and now through the use of HeartMath, she is no longer paralyzed with fear. Cynthia shared how she uses Heart Lock-ins to solve difficult problems during meetings. Yet another woman told the touching story of how HeartMath transformed a very stressful bath time routine with her son into a loving and special bonding time. HeartMath helped another staff member though a difficult time dealing with several family member's significant illnesses. The video ended with the CEO and executive assistant sharing about the transformed executive suite after HeartMath came into their lives. We will have to talk them into putting their video on YouTube. It was awesome!

Marielena Murphy and Linda Larkey from Scottsdale Healthcare gave a presentation about how research in nursing practice at their institution is helping to expand HeartMath usage among the care team. One of the projects they highlighted focused specifically in the surgical services department. Early indications of the project indicate there is likely a correlation between the practice of HeartMath and the reduction of adverse events. More research is necessary to find correlations with HeartMath and patient satisfaction, turnover, and employee satisfaction.

The second half of their presentation focused on how HeartMath coherence correlates with the meditative movement practice with breast cancer survivors. Watch for a journal article out soon indicating the very positive impact of both HeartMath and Qigong have on patients with persistent fatigue after treatment.

Lunch time and then an afternoon full of more stimulating presentations from the Mayo folks...There’s more to come from Santa Cruz!

Monday, May 9, 2011

Champions of Care - National Hospital Week

Champion: A valiant fighter. A person who fights for another or for a cause. A defender, protector, or supporter. A winner of first place; excelling over all others.

Care: To feel concern or interest. To feel love or liking. Charge, protection, custody.

These are definitions from Mr. Webster's dictionary. If you looked in Mr. Linden's dictionary, you will find four words, "Grinnell Regional Medical Center." I am very proud to work with men and women who live these words every day.

In a small community like ours, it is very common to know our patients as friends, family members, and neighbors. This is true whether they come to us from Montezuma, Iowa or Montana; Brooklyn, Iowa or Brooklyn, New York. Our location on I-80 brings many travelers to our doors. Students from Grinnell College come from across the country and around the world. It's true that people from all walks of life come into this hospital seeking medical help. GRMC staff provide remarkable care for everyone as neighbors and friends.

This is National Hospital Week. It is a time to celebrate and honor the important role hospitals play in their communities. This year's theme is, "Champions of Care."GRMC employees give all they have to be a champion for those we are privileged to serve. Over and over, the quality of healthcare provided at GRMC is recognized as some of the best anywhere.

Please join us Saturday, May 14, from 7 to 10 a.m. for a community breakfast in the GRMC cafeteria to help us celebrate National Hospital Week. We'll be serving made-to-order omelets with help from our friends at the Iowa Egg Council. There will also be educational exhibits of some of the services provided through GRMC. We hope you will stop by the hospital on Saturday morning and let us make you breakfast.

Tuesday, April 26, 2011

Mark Your Calendars for Upcoming Events!

Part of the fun of being a community hospital is celebrating the great relationship between GRMC and the friends of GRMC. We hope you can join us for some big events planned for the coming months.

GRMC Breakfast and Health Fair - Saturday, May 14, 7 to 10 a.m., at GRMC
Join us in the cafeteria for breakfast featuring made-to-order omelets, sausage, fresh fruit bar, mini-cinnamon rolls, and beverages. Come for breakfast and tour various informational displays on GRMC programs and services. We're partnering with the Iowa Egg Council on this fun event. Freewill donation will go toward our effort to purchase a new anesthesia machine for the GRMC surgery department.

GRMC Annual Golf Outing - Friday, July 22
This annual event brings together golfers from around the area. Golfers play nine holes in the morning and 18 in the afternoon on the beautiful course at Grinnell Golf and Country Club.

Blue Jean Ball - Saturday, September 24
Whether you wear stonewashed, designer, skinny jeans, or Levis, come enjoy an evening of dancing and fun. "The Dweebs" are a band with a wide following of fans throughout the Midwest. They play a little bit of everything for all who like to dance. There is also a great line up of silent auction items already coming together for this event. This is also the same day as the Optimists' Fly In Breakfast - head out with the family for French toast in the morning and come back in the evening for a night out with GRMC at Grinnell Municipal Airport.

Women's Health Focus and Baby Fair - Wednesday, October 5
Plans are coming together quickly for this great annual event. More than 400 women attend the Women's Health Focus and Baby Fair at Grinnell High School. Educational exhibits, vendors, prizes, giveaways, a fabulous meal catered by Mayflower Community, and an entertaining, inspiring speaker make this a wonderful night out for women of all ages.

Mark your calendars for these great events and make plans now to attend!

Tuesday, April 12, 2011

My 20-Week Ultrasound at GRMC

Guest blog – Ashley Grundler, Graphic Designer, GRMC

Last week I had my 20-week ultrasound. My husband held my hand as the ultrasound technician, Cassie, began to look at images of our baby. She carefully examined each body part and organ of the baby, and took lots of photos to send to our family physician (plus we were able to get a few).

The entire process took just under one hour. Baby Grundler made it a bit difficult by trying to hide some of the time. Cassie was great, and answered all of our silly questions… my husband’s main concern was making sure the baby had the right amount of fingers and toes. Then we asked Cassie to try to determine the gender of the baby. And while ultrasound is not 100 percent, she felt confident in saying we are having a baby girl!

At the very end of the ultrasound Cassie did some calculations to determine the size of the baby, and to see if my due date was accurate. As of last week, our baby girl is about four days ahead of schedule, and about an ounce and a half heavier than the average 20-week old fetus.

Overall this experience was amazing! We were able to see beautiful images of our little girl. We could see her move, wiggle, and hide her face behind her right hand. I am so happy I was able to experience this miracle at GRMC!

-Ashley Grundler

Wednesday, March 23, 2011

A Wider Audience with Hospital Impact

Recently, I was invited by the editors of Hospital Impact to submit posts from time to time for their blog. Here's a link to my first post!

Friday, March 11, 2011

GRMC Keeps Me Healthy During My Pregnancy

Guest blog - Ashley Grundler, Graphic Designer, GRMC
I feel very fortunate to be having my first child with the care and support of Grinnell Regional Medical Center. Not only will my family physician deliver my baby at GRMC, I'm also taking advantage of all the hospital has to offer expecting moms.

A few weeks ago, my husband and I began yoga classes at Fly High Fitness Studio. We joined the basic class offered on Tuesday and Thursday evenings. The instructor, Jen Ness, has walked us through the poses, and is always so sweet and encouraging. She assures us that with practice we will be able to do the moves like she does...though I have my doubts.

So far, the yoga class has been wonderful for my back and I feel so refreshed and relaxed. And while my husband originally joined me for moral support, he now loves the class, too.

I want to stay healthy during my pregnancy, so taking advantage of gentle classes at Fly High Fitness Studio has been great. And with our wellness membership, we can also use the PWA Fitness Center. I can use the treadmills to walk at my own pace or do a little strength training.

GRMC gives the me the ability to receive all my prenatal care right here in Grinnell.

The radiology department will give me my first ultrasound in a few weeks. Hopefully the baby cooperates so the ultrasound technician can determine whether we're having a boy or a girl! I will share a post on what we find out.

The Kintzinger Women's Health Center offers prenatal and childbirth classes for expecting parents and we will begin attending this summer. The wonderful staff will help my husband and me through all our questions and concerns. As first-time parents, I know we'll have a list for them!

I am so excited to have the knowledgable staff at GRMC help me through my pregnancy. And as we experience new services at the hospital, I will be sure to share it with all of you.

~ Ashley Grundler

Friday, February 18, 2011

482 People Head to the Desert

Earlier this month, I had the privilege of serving as moderator for the Health Forum’s National Rural Health Leadership Conference in Phoenix. With a record attendance and stellar presentations, the meeting was a smashing success. Laura Woodburn, executive director of education for Health Forum, and her team hit another one out of the park this year.
We started with an amazing keynote from Dr. David Auerbach regarding his experience in Haiti immediately following the devastating earthquake. His courage, resilience, skill, and compassion saved thousands of lives as he led the effort to re-establish the hospital in Port-au-Prince. It set the tone for the conference by reminding us all what a privilege it is to serve others, even in the most trying of times.

We ended the conference with Robert and Rebecca Bluestone. Their wonderful story, “Woven Harmony,” tells how the arts can help to create an optimal healing environment. Her truly extraordinary silk weaving and his masterful classical guitar playing left us all with a sense of renewed passion and creativity in returning to our hospitals to advance our mission of service. Tom Atchison, Dr. Clint McKinney, Gov. Ronnie Musgrove, Tom Morris, Lisa Kidder Hrobsky, Jamie Orlikoff, and Dr. David Blumenthal rounded out our keynote speakers

During the conference, participants did a lot of heavy lifting. We discussed what healthcare reform really means for rural hospitals. What is an Accountable Care Organization and will it work in our rural communities? What about physician integration? What’s new in Washington, D.C., and what does the National Advisory Committee for Rural Health and Human Services do to support our activities back home? We also heard several presentations about “meaningful use.” Sessions on governance were also popular since more than half of the conference participants were hospital trustees.

Although the weather in Phoenix was unseasonably cold, the high temps for the day were actually record-setting it was that cold for Phoenix, it beat the extreme cold and blizzard-like weather elsewhere. Check out the ice on the fountain in the courtyard of the hotel… icicles should not be in the desert! One of the largest winter storms in history disrupted travel home for many of the participants, and a few even got an extra day or two in the desert.

Despite the chilly temperatures, the speakers and the conference were a great educational opportunity. We headed home with new information and ideas to meet the challenges ahead for our mission to healthcare for rural communities.

If you are a rural healthcare trustee, administrator, physician, or vendor and have not yet experienced this conference, I highly recommend it. The venue, sponsors, speakers, and interaction with others make this a worthwhile and great event. It would be fun to have over 500 next year. Save the dates, February 5-8, 2012, on your calendars and plan to join us!

Friday, February 4, 2011

The Magnet is in The House!

Everyone is welcome to an open house this coming Monday, Feb. 7, from 4 to 6:30 p.m. to view our new Magnetic Resonance Imaging unit. Join us in the Tomasek Conference Center at GRMC. Staff will take guests on tours of the new MRI suite, answer questions, and provide information about this incredible diagnostic imaging equipment. Please come help us celebrate. More than 430 people donated $322,000 to help make this possible and that's pretty cool. Magic happens when a community makes an investment like this for the greater good. My thanks to all those who supported the effort to make this MRI available for GRMC patients.

As you might imagine, I have been watching the installation of our new 1.5 tesla magnet with great interest. This wonderful new piece of technology is already being used by our patients.
With the extreme winter weather we've had lately, it is especially wonderful to have the MRI inside. Patients have had to be taken outdoors in all kinds of weather to get to the mobile MRI unit and now, they can stay indoors.

A few weeks ago, our MRI technicians were learning the new equipment and needed a volunteer to work with. I've had an MRI on my back, so we had a previous scan to compare with from several years before. Not only was the scan itself a piece of cake, the difference between the images was impressive. Even to my untrained eyes, the difference was unbelievable.

It's great to have the magnet in the house!

Monday, January 31, 2011

Training is Overrated

If you read this blog somewhat regularly, you know I am a major supporter of fitness and wellness activities. Our hospital has developed a very intensive wellness program as part of our self-funded health insurance program. Over the past three years we have truly bent the cost-curve of our health plan with an average increase of 2.5 percent or less annually. That compares very favorably to the national average of about 11 to 13 percent annually for hospital health plans. At its core, I believe our success has been our incentives for our employees to improve their health. Exercise, stress management, screenings, tobacco reduction, and diet management are but a few of the things that makes our plan a winning combination for not only reducing cost, but improving health. This, in turn, improves morale, productivity, and a greater sense of wellbeing.

As the leader of GRMC, I really believe I need to try my best to be a role model of these behaviors. The more I have engaged in the wellness program, the better I have felt and the healthier I am getting. So much so that I recently participated in a half-marathon.

(Pause for laughter...)

Why the pause? Because those of you who know me personally may know that I am not much of a runner. Although I was a cross country and long-distance track runner in my youth, my knees simply ache too much to run these days. My daily exercises consist of walking and using my elliptical machine. But a half-marathon?

My girlfriend Angie has participated in the PF Chang Rock and Roll Charity Marathon in Phoenix for the past two years and wanted to do it again this year. Since my parents winter in Phoenix, we decided to make it a long weekend and I signed up for the half-marathon. I have learned that a person really ought to train a little bit before taking on 13.1 miles!

I did survive - and bless her heart - Angie hung back with me as I mostly walked the course along with thousands of others who walked and jogged the trek from Phoenix to Tempe. In all, 30,000 people participated in the two events and it was really a lot of fun. I was glad to have participated and look forward to my next attempt, perhaps with a little more training and some Glucosamine and Chondroitin for my joints!

If you have set yourself a goal this year to become more active, I encourage you to visit with one of our wellness professionals at GRMC to help you develop a plan to reach your goals.

Monday, January 10, 2011

It’s About Wellness

Guest blogger, Cory Jackson, director, GRMC Wellness Services

We’re one full week into the New Year! How are you doing with your resolutions? It may have seemed easier to make a resolution around personal health last weekend when most of us were enjoying the holiday, seeing friends and family, watching football, and having fun. But as Monday morning rolls along and the first week after the holiday season is over, reality starts to do a number on our good intentions.

If your resolution has started to wane a little, don’t worry. You are not alone! GRMC offers a variety of fitness and wellness options for you. Check out our website to find what appeals to you.

Maybe you like to dance? Aerobic dance is one of the hottest fitness trends out there and we offer Cardio Party at Fly High Fitness Studio in downtown Grinnell. Check out the schedule of classes here.

Spinning is hugely popular and we have several classes that can work into your busy schedule. Spinning takes you on a virtual bike ride via a stationary spinning cycle.

Boot Camp, yoga, core fusion… there are many choices. Invite a friend to join you! Studies show that we can be more successful when we have a buddy. And, by coming regularly, you will meet new friends through your classes who will miss you when you don’t attend.

The Paul W. Ahrens Fitness Center at GRMC has treadmills, elliptical machines, treadclimbers, recumbent bikes, and a full complement of weight equipment for your use. The PWA Fitness Center is always staffed by a wellness specialist to answer your questions.

If you need a little more motivation, ask about our It Pays to Attend program. When you attend 60 times within a six-month time period, we will reward you with a certificate for a 60-minute massage. How’s that for motivation?

Of course, we all know that eating less and doing more sit ups will help us drop a few pounds and feel better physically. So, why is that so hard to do? We think stress plays a huge role. Exercise is a wonderful stress reliever, but so is massage therapy. During these cold winter months, make it a point to get a massage regularly at Postels Community Health Park. Work out those stress-filled winter muscles with a warming hot stone massage. A full menu of wellness services can be found at our website.

We’d love to visit with you about your personal wellness, body, mind, and spirit. When we focus on our health, we are better able to meet the challenges of our everyday. Make your resolution about your overall wellness and it will help you in ways that go beyond diet and exercise to really enriching your life in all areas.