Everyone’s heard that old saying about jumping out of the frying pan and into the fire. Well, I lived it.

Wouldn’t you know…my first day on the job as director of marketing at Palm Beach Gardens Medical Center was Wednesday, Sept. 1, and Hurricane Frances was making a beeline straight for South Florida. As an “outsider” of sorts, I was privileged to observe well-conceived emergency preparations efficiently unfold and work alongside great people who, over the course of several days, accomplished extraordinary things.

Having lived in South Florida my entire life, I’d made hurricane preparations before, but never for a hospital. No time for a learning curve. Thankfully, the hospital already had a plan in place for any type of disaster and my role was clearly outlined. I was able to jump right into work under the guidance of our Director of Human Services, Karen Smith, who was a true guiding light.

What I saw was the level of compassion and concern that hospital administrators had for the employees, patients and their families, and the teamwork, camaraderie and care everyone felt and exhibited. It was always clear that, although employees were needed to keep the hospital operating for the community good, family came first. It also struck me that many employees are as loyal to their PBGMC family as their biological ones!


Director of Human Services Karen Smith takes down license information from one of the Good Samaritan Medical Center nurses who accompanied patients evacuated from Palm Beach Gardens Medical Center’s sister hospital in downtown West Palm Beach.

As problems arose, they were quickly addressed. When public schools closed for two workdays, we weren’t sure employees with children would be able to make day care arrangements. So Karen helped set up our very own day care area and Betty Webb, Environmental Services executive assistant, and Kay Brown, Medical Staff Services director, shared responsibilities for running it.


Members of the hospital engineering staff, wet from venturing outside in the rain to rectify problems include (from left) Jim Earlman, Mike Murphy and Dino Gavazza, Director of Plant Operations.

As the storm approached, David Mowery, James Cawley and members of their Food and Nutrition staff worked around the clock preparing the kitchen to serve everyone hunkered down there. Dino Gavazza, Director of Plant Operations and his engineering team tirelessly labored to ensure the building was ready. Everyone in housekeeping took extra care readying the hospital for the increased number of people that would be staying, including making sure bedding and linens were available.

I witnessed scores of RNs, including Jackie Lockamon, Katie Boggs, Shirley Bonvento, Darlene Stack and Jessica Goforth, all PBGMC charge nurses, as well as nurses from our sister hospital, Good Samaritan Medical Center in West Palm Beach, volunteer to work beyond their regular shifts, knowing full well they might have to remain once conditions deteriorated and replacements were out of the question. Still, they stayed to ensure quality care was provided to patients until relief could come.

Nursing supervisors Bert Ortiz, Jim Hill, and Lauren Press, and Telemetry Director Kim Ortiz, also an RN, often went without sleep to keep our hospital running and our patients, visitors and nurses comfortable and safe. Janet Tursi, Director of Women’s Services, managed care for an additional 18 pregnant women who were brought in from area shelters, calming and comforting them throughout the storm.


Chef James Cawley poses in the kitchen with Kelly Smith (left) and Jen Lawson, two of the volunteers who helped feed staff and family staying at the hospital during Hurricane Frances.

Because space and bedding were limited, department heads and administrators slept in their offices. Nurses on 12-hour shifts slept where they could, taking turns while the other shift worked. Karen Smith not only coordinated day care logistics, she tirelessly worked to ensure everyone had sleeping accommodations. If patient rooms needed to be sterilized, administrators and employees pitched in to clean the rooms. Right there among the volunteers were hospital CEO Mary Jo Gregory, Chief Nursing Officer Beverly Thomas – even children of employees. I don’t remember hearing complaints. Rather, staff asked what more could be done.

During final preparations, just before Frances hit, the electricity went out. I was further impressed when I saw this did not daunt staffers from performing their duties. Through the night, I witnessed many brave acts by our engineering team, including Dino Gavazza and Mike Murphy, who, at the height of the storm, unclogged a parking lot drain to prevent flooding and John Caldwell, who, in 100 mph winds, maneuvered a truck onto a detached piece of roof to make sure it did not fly into the hospital or surrounding cars and cause potentially fatal damage.

Following the storm, even in the heat, with no running water, morale remained high and, through sheer dedication and will-power, the hospital stayed up and running, thanks to many loyal employees too numerous to name.

I saw a lot of heroes at work. How many people can make that claim during their first few days on the job? To all of them, I extend my utmost gratitude and admiration.



Health care is changing. Well known medical surveys report that approximately 50% of Americans are using complementary or alternative therapies. Research has shown that these therapies can help lessen anxiety, reduce pain, boost the immune system, and accelerate healing. When patients choose these options, there is a greater sense of participation and empowerment, and patient satisfaction is often increased.

These therapies are grouped under the heading of Complementary and Alternative Medicine (CAM)1. Complementary means that it’s used together with conventional health care. Alternative means that it’s used instead of conventional medicine.

CAM therapies can be divided into five major categories:

  1. Alternative Medical Systems, such as Homeopathy & Naturopathy, and Traditional Chinese Medicine & Ayurveda.
  2. Mind-Body Interventions, such as Meditation, Prayer, art, music and dance.
  3. Biologically based Therapies, such as herbs, foods, vitamins and supplements.
  4. Manipulative and Body-Based Methods, such as Chiropractic & Osteopathic manipulation, and Massage.
  5. Energy Therapies, divided into Biofield Therapies and Bioelectromagnetic-based Therapies:
    • Biofield Therapies affect the energy fields surrounding and penetrating the body, such as Reiki.
    • Bioelectromagnetic-based Therapies make use of electromagnetic fields such as pulsed, magnetic, alternating- or direct-current fields.

Reiki (RAY kee)

Reiki is a simple energy therapy that restores homeostasis to the body, equilibrium to the mind, and fulfillment to the soul. It’s applied with the hands according to the needs of the client, without pressure or manipulation. The recipient draws the needed healing energy without effort. There are no side-effects or contraindications associated with Reiki. It’s non-invasive and suitable to every age group and symptom.

Research is increasingly showing that when the body breaks down, the effects of emotions, attitudes, thoughts and relationships are to be taken seriously. Our bodies don’t operate as islands onto their own, separated from the rest of us, and are in fact sustained or made ill by a variety of factors. The thinking that because the body is physical only physical, mechanical and organic factors influence its health is being steadily debunked.

Even when dealing with the body alone, a similar idea is at play: Liver disease can’t be addressed only by concentrating on the liver, as that organ lives in a complex body, a complete system that intricately interacts with itself.

One reason CAM therapies are gaining respect in medical circles is because most of them have a holistic2 approach, which has shown to be more effective in treating chronic conditions and lowering costs by addressing prevention.

According to the National Center for Complementary and Alternative Medicine, Reiki is a word representing Universal Life Energy. Reiki is based on the belief that when spiritual energy is channeled through a Reiki practitioner, the patient’s spirit is healed, which in turn heals the physical body.

Energy Flow

It’s helpful to know that healing traditions have existed since the dawn of humanity, predating the Western biomedical model. In these traditions, the ability to administer healing comes from knowledge and practices that are passed on from expert practitioner to student, who in turn becomes an expert practitioner. One of the core concepts of such teachings is that everything in the universe is made up of energy and this “life energy” flows all around us and is drawn in by the body nourishing the cells, organs, and glands. This same energy also radiates from the body. Energy flow in the body is not an easily understood or accepted concept. Simply put, when one’s energy is depleted, imbalanced, or the flow is restricted, one is more susceptible to discomfort, further illness, and disease. When one’s energy is restored, free-flowing, or balanced, the body’s innate healing abilities are restored and activated.

Reiki is a low-risk intervention, which means it does no harm. By rebalancing the biofield, Reiki treatments address the whole person. A person receives Reiki healing on a treatment table, fully-clothed, with dim lighting and relaxing, inspiring music in the background for about 60 minutes. A minimum of 4 complete treatments is recommended before assessing clinical benefit.

Our bodies are like walking biographies, containing all the various experiences and influences of our lives. Healing energy goes to the most needed component of our make-up: Social, mental, emotional and physical, or a combination. Deep relaxation is experienced almost immediately and this in itself leads to the resolution or improvement of many conditions. Reiki treatments are insightful, uplifting and profoundly comforting. The body truly appreciates the care and kindness it receives and responds favorably.

A unique feature of Reiki is that it can be easily applied to oneself, making it a resource of self-care. Anyone can learn this great art; the ability to tap into the universal “life energy” is not dependent on intellectual capacity, belief, or innate skill.

New Perspective

One important factor that needs emphasis is that Reiki is spiritual healing first, and as the spirit heals, there’s a ripple effect reaching other aspects of our existence. This is possible because spirituality is the one overarching, inclusive component, unifying all aspects of our life and being by giving meaning and structure, and empowering us to live from a core of our deepest values. People with a strong sense of spirituality are less in need of medical services, show resilient emotional health in the face of terminal illness, and have lower discomfort and loneliness. Such people cope better with life crises, have an expanded perspective and are able to interpret illness to produce spiritual growth. Whether it’s receiving treatments for yourself, or learning Reiki as self-care and for your loved ones including pets, Reiki is a beautiful gift in its simplicity and profound, direct healing effect, as exemplified by the following 5 Reiki precepts. Please feel free to put these in action and be well!

Just for today, do not anger.
Just for today, do not worry.
Be humble.
Be honest in your work.
Be compassionate to yourself and others.

  1. As defined by National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health. NCCAM is the Federal Government’s lead agency for scientific research on CAM. NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.
  2. Dealing with the patient as a whole human being, it considers not only physical health but also the emotional, spiritual, social, and mental well-being of the person. In looking at the body it sees not only the parts, but the sum and seeks healing by considering the entire system, rather than simply ‘fixing’ a part.

© 2004 Pamir Kiciman



In a speech presented last year at the University of Pittsburgh Medical Center, Donald J. Palmisano, M.D., J.D., immediate past president of the American Medical Association, warned of the daunting problems threatening medical education today. But Palmisano also reassured his audience, explaining the leadership role that the AMA has assumed, and challenged them to join what he considers a fight for the future of medicine.

Palmisano believes that without a strong, healthy system of quality medical education, the American health care system cannot survive. Medical education is the foundation of medical care – but the nation’s medical education systems face complex problems that are resulting in physician shortages and other negative consequences. The AMA is intervening on many levels to reverse the trends and transform the situation into one that benefits the medical students, the medical profession and ultimately, the entire health care industry. Working through affiliated organizations, including the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME) and the National Board of Medical Examiners (NBME), the AMA is playing a vital advisory and advocacy role.

The problems confronting medical education include the overwhelming debt accrued by medical students, the decreasing numbers of minority students, the problem of safe and reasonable work hours for resident physicians and the medical liability insurance crisis.

“High debt is a deterrent to enrolling in medical school,” says Palmisano, “and that debt has been steadily rising. The median debt for med school graduates is five times higher today than it was just twenty years ago. While 1984 graduates left school with $22,000 – 26,000 of debt, today’s graduates of public schools will owe $100,000 and graduates of private schools will owe $135,000.” The debt is staggering and loan repayment is expected to begin simultaneously with one’s residency – hardly an opportune time to manage such a financial burden. One of the dangers of this is that medical school could become an option only for the affluent.

According to Palmisano, “The problem of medical debt tends to be more of a problem for minority students, and we need diversity in the profession. We need physicians who can provide culturally relevant care. Medical student debt influences choice of specialty, driving students away from the lower paying specialties and endangering care in underserved communities.” Medical school enrollments have not kept pace with America’s growing and graying population and the AMA has called for a 16% increase in medical school enrollments, emphasizing minority and foreign students, to meet the need.

The AMA has acted to ease the financial burdens facing medical school graduates, lobbying for tax relief, loan forgiveness, delayed repayment plans, scholarship programs and tuition reimbursement programs, at the federal and state levels.

Another concern is resident work hours. Safety and training needs must be balanced, giving resident physicians reasonable work hours and working conditions while making certain that patient care and medical training are not compromised. New guidelines, developed with the ACGME and the AMA’s House of Delegates, the organization’s policy-making body, went into effect in 2003 and the AMA is monitoring their effectiveness as well as compliance with them in the nation’s teaching hospitals.

While medical school debt, recruitment of minorities and resident work hours are all significant issues that impact heavily on the medical profession, the issue that takes priority is the medical liability insurance crisis. The problem has reached crisis proportions in twenty states and Palmisano says that it is clearly a national problem and one that the AMA must solve.

Skyrocketing medical liability insurance costs and “runaway juries” have driven doctors away from those specialties that are more at risk for lawsuits, particularly obstetrics, orthopaedics and neurosurgery. Premiums are so high in some states that young doctors leave the state after completing their residencies, setting up their practices in states where liability insurance is more affordable. This exodus has created a growing shortage of physicians in certain states and specialties, even closing down obstetric practices, maternity departments and trauma centers and limiting patient access to care.

The nation’s medical liability system is broken, says Palmisano, a peripheral vascular surgeon, and the American people and a majority of our Congressmen recognize that and support reform. Opponents of liability reform like to say that litigation reduces errors, making doctors more careful and making patient care safer. But Palmisano argues that that is simply not the case: errors arise from poorly defined systems, not from careless doctors. Patient safety is an important issue, but it is a separate issue and one that is also being addressed by the AMA. Reduction of medical errors will come about through the National Patient Safety Foundation, which the AMA helped to create, and will depend upon identifying the flaws in the systems that allow mistakes to occur. A key component of enhancing patient safety is for Congress to pass the Patient Safety and Quality Improvement Act that allows confidential voluntary reporting with review by experts, feedback to change the flawed system and sharing the lessons learned with all. This bill passed the House and Senate but time ran out to get it out of conference committee in the last Congress.

The AMA is the nation’s premier medical organization, providing a clear, strong and authoritative voice for the medical profession and medical students and representing the interests of physicians and patients in Washington. Despite the many problems that beset medical education, the practice of medicine and the health care industry in general, Palmisano is confident that the AMA is leading the way to a future of essential renewal and transformation. He encourages physicians and medical students to become members, furthering strengthening the organization through numbers and solidarity, adding their voices and allowing the AMA to speak on their behalf as they tackle the issues and create a better future for medicine.



CARF (Commission on Accreditation of Rehabilitation Facilities) has announced that the Health Care District’s skilled nursing facility, Edward J. Healey Rehabilitation and Nursing Center, has been accredited for a period of three years for its Inpatient Rehabilitation Program—Skilled Nursing (Adults) program. This is the first accreditation that the international accrediting commission has awarded to the Healey Center.



If a picture is worth a thousand words, how much is a thousand words worth? As a spring 2005 Leadership Survey of hospice organizations shows, quite a lot! Conducted by the National Hospice and Palliative Care Organization and the Furst Group, the survey provides a challenging snapshot of end-of-life issues facing hospice organizations.

As hospices begin their third decade of existence in this country, one finding is that 82 percent of the executives responding to the survey were over the age of 45, which pointed to a leadership shortage within 10 years. In the context of that shortfall, the survey showed that leadership development and succession planning were key to tomorrow’s success. When the picture was enlarged to encompass the question of what one thing would best prepare hospice organizations for the future, respondents chose “becoming a learning organization.” What does that mean?

Nearly two decades ago Peter Senge’s bestseller, The Fifth Discipline, presented a revolutionary approach to the practice of management by introducing the theory of learning organizations to business. It was written during a time when America was trying to cope with the threats posed by Japan’s early adoption of the Deming approach to quality management. Among other things, the book challenged American business and industry to begin creating shared vision, implementing team learning, and incorporating systems thinking into their organizations.

Historically, hospices were primarily founded and managed by RN’s and social workers and were focused on delivering clinical and social services to dying patients and their families. Becoming a learning organization was not on their short list of things to do, and, in fact, better managing Jim or Betty was generally not on that list either. If Jim and Betty were breathing and knew their job, hospice management expected them to lead, follow, or get out of the way, because there were dying patients and their families to care for! In those days, our shared vision was taking care of the sick and dying in the best way possible with little or no thought given to leadership and management development.

Team learning consisted of nurses, social workers, aides, chaplains, physician, and volunteers knowing something of the others role, but each too busy helping patients and families to think systemically. There was no time to consider how our various services and tasks were part of an integral whole. While we talked about our interdisciplinary team approach, we did not think in terms of systems and certainly not in terms of our organization as a behavioral system – a culture. We were not alone; most businesses in America were also doing their “own thing” with little regard for thinking about the integrative, cultural aspects of their organization – hence, the popularity of Senge’s book.

The good news is that since those early years of hospice, the picture has improved. We have new management terms, concepts, and tools with which to analyze our strengths and weaknesses, evaluate our services, and even examine our niche in the marketplace, but like healthcare in general, the survey shows we lag other organizations in developing the necessary leadership and management capabilities of our staff. Even though we are committed to the principles of continuous improvement in the clinical area, we still fall short when it comes to improving organizational leadership and management.

The good news is that the skills necessary for becoming a learning organization can, themselves, be learned. Survey respondents were able to identify specific educational and management needs necessary to create a learning organization and develop the next generation of leaders. Hospice organizations need employees who work with others to create clear direction and vision in themselves and those around them, create excellent customer service, build effective teams, and practice sound financial business management.

While it is recognized that good managers could become better ones through proper education and training, a consequent realization is that without people development, there is no organization development, and without organizational development there is eventually no organization. A crucial insight!

In the hierarchy of adaptive, flexible organizations, hospices are not on the cutting edge. Technology companies usually hold that distinction. Hospice, however, do have the knowledge to reinvent themselves even in an era of tighter budgets, consolidations, competition, and constrained Medicare and Medicaid funding. By providing information about where we are and where we need to go to create a better and brighter future, this leadership survey challenges hospices to begin that task. Not a bad snapshot – in fact, a picture worth a thousand words.