Children’s Hospital & Medical Center

1.2011

Contents

4 Inspiring Discovery

8 Health Care Reform Top Ten

14 Racing to Save Lives

20 Master Mind

24 Solid Past, Bright Future

Spira

Spira is the biannual magazine of

Children’s Hospital & Medical Center,

8200 Dodge St., Omaha, NE 68114.

Spira@ChildrensOmaha.org

SpiraMagazine.org

On the MapWhen it comes to pediatric subspecialty care, Children’s Hospital & Medical Center is on the map as one of the best in the nation. Children’s ranks in the top 50 pediatric health care centers for cardiology/heart surgery and orthopedics in U.S. News & World Report’s 2011-12 Best Children’s Hospitals rankings.

“We’re honored to receive this recognition which helps to highlight Children’s Hospital & Medical Center on a national scale,” said Gary A. Perkins, FACHE, president and chief executive officer of Children’s. “We’ve long known that we are a top provider of high quality pediatric health care. Being ranked among the Best Children’s Hospitals provides affirmation from an objective, outside source.”

“We salute Children’s Hospital & Medical Center,” said Health Rankings Editor Avery Comarow. “The goal of the Best Children’s Hospitals rankings is to call attention to pediatric centers with the expertise to help the sickest kids, and Children’s is one of those centers.”

The American Nurses Association (ANA) has recognized Children’s Hospital & Medical Center with its top honor. Children’s received the 2010 National Database of Nursing Quality Indicators® (NDNQI®) Award for Outstanding Nursing Quality in the pediatric hospital category.

“This is an incredible accomplishment that refl ects the dedication and professionalism of each and every nurse at Children’s Hospital & Medical Center,” said Pam

Carlson, MSN, RN, NE-BC, chief nursing offi cer and vice president of patient care at Children’s. “This is the highest award available in the nursing profession directly related to patient outcomes.”

The award is based on an independent review of nursing outcomes data from more than 1,700 hospitals. Children’s is one of only fi ve hospitals to be honored nationally, and the only pediatric hospital winner.

“This is an incredible accomplishment that refl ects the dedication and professionalism of each and every nurse at Children’s Hospital & Medical Center.”pam Carlson, MSN, rN, NE-bC

Qualityn. 1. an essential or distinctive characteristic, property, or attribute. 2. Character with respect to fi neness, or grade of excellence. 3. High grade; superiority; excellence.

DISCOVERYINSPIRING

Shelby kutty, M.D.

THE VALUE OF HIGH QUALITY MEDICAL RESEARCH CAN BE MEASURED MANY WAYS. IT BRINGS

FAME AND MUCH-NEEDED GRANTS AND OTHER FUNDING TO HOSPITALS. IT SHINES A SPOTLIGHT

ON EXCEPTIONAL PHYSICIANS AND HEALTH CARE PROFESSIONALS WHO EXHIBIT INITIATIVE AND

INSATIABLE CURIOSITY. IT GARNERS HEADLINES AND EARNS AWARDS.

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The specialists at Children’s Hospital & Medical Center say there is another reason research is valuable, one that surpasses all others: it enables them to better fulfi ll Children’s mission, “So that all children may have a better chance to live.”

“It is our privilege to care for children using established treatments, medicines and procedures,” says John W. Sparks, M.D., chairman of the Department of Pediatrics at the University of Nebraska Medical Center (UNMC) College of Medicine. “But it’s even more of a privilege to be able to advance the fi eld through exceptional pediatric research.”

Research like that being conducted by pediatric oncologist Minnie Abromowitch, M.D., who helps develop and administer treatment protocols that impact the care, and the lives, of young cancer patients around the world.

And Edward Truemper, M.D., Director of Critical Care Research at Children’s, whose senior efforts have resulted in Children’s becoming the top enroller in the nation in clinical trials of pediatric surfactants, or surface-active substances.

And Jessica Snowden, M.D., whose research into pediatric central venous catheter infections has earned her a fi ve-year development award.

And Shelby Kutty, M.D., Director of Cardiac Imaging for the Joint Division of Pediatric Cardiology, and the fi rst pediatric cardiologist to receive a three-year development award from the American College of Cardiology Foundation. The award and accompanying funding come on the heels of Dr. Kutty being named the fi rst pediatric cardiologist in the nation to receive the Arthur E. Weyman Young

Investigator’s Award of the American Society of Echocardiography.

These are just a sample of the fi restorm of pediatric research projects underway at Children’s, many of them sparked by the 2007 institutional affi liation agreement between Children’s and the UNMC College of Medicine aligning resources to enrich education, research and clinical care opportunities.

“We have witnessed a dramatic expansion of the number of research projects since entering into the affi liation agreement,” says Dr. Sparks, who serves as chief academic offi cer at Children’s. The agreement helped to lay the groundwork for the creation of the new group practice comprised of more than 120 pediatric specialists at Children’s who are also faculty members at UNMC.

Indeed, the number of research projects has risen from 18 in 2008 to 60 in 2010. At the same time, the number of presentations delivered at the annual Resident Research Forum has grown 80 percent. Dr. Sparks credits the joint Children’s/UNMC Pediatric Research Offi ce, and the creation of a single Institutional Review Board (see sidebar) as instrumental in furthering research development.

“Clearly, both UNMC and Children’s Hospital & Medical Center are committed to developing research in various areas of pediatric medicine,” he says. “That means we will recruit new faculty and provide the resources — money, inventory and an environment supportive of research.

“All these things are necessary to come together and help that seed grow and bear fruit.”

john w. Sparks, M.D.

Edward Truemper, M.D.

jessica Snowden, M.D.

“By conducting research on a daily basis in an organized way using better methodologies, I am working to improve outcomes for children everywhere.”Shelby Kutty, M.D.

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In Dr. Kutty’s case, the research seed has sprouted like Jack’s famous beanstalk. He is involved in no fewer than 15 projects — so many that research now occupies 50 percent of his time.

As an assistant professor of pediatric cardiology and radiology at UNMC, Dr. Kutty shares his knowledge with students. He says not only does research yield advancements in pediatric medicine and care, it also produces better clinicians. “Because you are abreast with the latest literature, the natural history and effects of treatment, and the most recent advanced and studied therapies, you tend to treat in the most advanced way,” he says.

Of his current projects, the one he puts at the top of the list is the study of the effect of systemic microbubble infusion via therapeutic, three-dimensional ultrasound-guided high mechanical index impulses to enhance pediatric venous and arterial sonothrombolysis.

Put a bit more in layman’s terms, Dr. Kutty is studying how microbubbles can be used to improve ultrasound’s success in dissolving thromboses — blood clots — to promote better blood fl ow and proactively reduce their occurrence and subsequent risk of stroke. Combining the technique with 3D echo imaging, for which Dr. Kutty is recognized as an expert, allows the cardiologist to precisely guide the impulses and see the results.

This revolutionary treatment could benefi t many pediatric patients, such as those who undergo long-term central catheter placement, those who have tubes surgically implanted in their hearts, or children who have suffered brain strokes — three situations which often result in blood clots.

While his research is ongoing, “So far, the results look quite promising,” he says.

Balancing his clinical and research duties, fi nding the time to document his results for publication (he has averaged fi ve papers a year the past three years), and making room for his family require dedication and perseverance. Luckily, Dr. Kutty says he loves what he is doing.

“Absolutely,” he says. “There are so many things in clinical medicine that are still unknown. I ask questions and then I investigate. I’m basically trying to fi nd answers to things less studied, less known.

“By conducting research on a daily basis in an organized way using better methodologies, I am working to improve outcomes for children everywhere.”

Dr. Sparks says Dr. Kutty is just one of pediatric medicine’s many rising stars currently conducting research at Children’s and UNMC.

“They are proving to be very competitive because they take the ideas they have, work with the Pediatric Research Offi ce, develop their data and then obtain funding awards to expand their research and discovery,” Dr. Sparks says.

With the encouragement and support of Children’s and UNMC, he says, “Dr. Kutty has rapidly become a nationally prominent cardiologist and noted cardiac researcher. That caliber of recognition refl ects in both directions.”

The Children’s Hospital & Medical Center and University of Nebraska Medical Center College of Medicine joint Pediatric Research Offi ce (PRO) and Institutional Review Board “are very much complementary,” says John Sparks, M.D., chairman of the UNMC Department of Pediatrics.

The PRO is staffed by fi ve people, chiefl y research nurses, and is funded with money set aside from the four-year-old affi liation agreement between Children’s and UNMC, including the pediatric enrichment fund, says Dr. Sparks.

“The PRO helps investigators defi ne and develop their protocols and make certain they are written well enough to pass through the Institutional Review Board (IRB),” he says. “Once approved, the PRO helps execute the details of the project, by identifying study subjects, providing a nurse at the bedside when the researcher comes in, and assisting in compiling and analyzing the data.”

The IRB combines what once were two review boards into a single entity, greatly streamlining the application process, Dr. Sparks says. The board includes pediatric experts from Children’s and UNMC, and two community representatives, who review proposals to make certain the projects are safe for the children who participate, as well as ethically sound.

“The PRO and the IRB function independently,” he says, “and both are very important elements in our overall effort to further pediatric research.”

7

HEALTH CARE REFORMTOP TEN

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It’s also good advice for pediatric hospitals facing the uncertainty of health care reform, says Children’s Hospital & Medical Center President and CEO Gary A. Perkins, FACHE.

“As we look toward our future and health care reform,” he says, “the underpayment for care provided by children’s hospitals under the Medicaid program has the potential to become even more acute.”

“Be prepared” is a mantra for good Scouts everywhere.

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Children insured by Medicaid typically require more care than other patients, yet Medicaid reimburses only 70 cents on the dollar of cost. That is why Medicaid Disproportionate Share Hospital (DSH) payments are critical.

And yet, even with DSH payments, Medicaid reimburses children’s hospitals an average of only 76 percent of the cost of providing care. “Any further reduction in reimbursement,” Perkins says, “creates the potential for an incredible amount of fi nancial stress being placed upon all pediatric care providers.”

When it comes to other aspects of federally-mandated reform, Children’s already has taken many steps to be in a better position.

“With reduced reimbursement, you have to fi nd ways to become more effi cient in the delivery of care without compromising quality,” Perkins says. “We’ve been a model in that regard for years.”

Prevailing health care trends indicate ten key areas of potential impact for health care reform.

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Health care reform may include penalties for readmission within a certain time period, or for infections associated with medical equipment or those developed post-surgery. There is an effort to link reimbursement with performance or outcome.

“We made quality job one at Children’s a long time ago,” Perkins says. “For nearly a decade, we’ve been able to measure quality through the scorecards we keep.”

These scorecards track performance in both the Newborn and Pediatric Intensive Care Units, in each hospital unit, and in outpatient services and clinics.

“By tracking and compiling the information from these scorecards, we not only know how well we’re doing, we also better understand what we need to do to attain our goals,” he says.

HITECH stands for Health Information Technology for Economic and Clinical Health Act. Not a direct component of health care reform, it is funded by the American Recovery and Reinvestment Act. It rewards medical facilities and organizations that prove “meaningful use” of electronic medical records.

Children’s is widely recognized as a leader in the use of technology and the implementation of electronic medical records (EMR) systems, and is a founding member of the Nebraska Health Information Initiative, or NeHII.

This January, Children’s was recognized as the top winner in the 2011 Healthcare Informatics Innovators Award Program. In 2009 and 2010, InformationWeek magazine ranked Children’s among the top 200 companies and organizations in the nation for innovation in the use of information technology.

“InformationWeek covers all industries, not just health care,” Perkins adds. “And we are one of only fi ve children’s hospitals on the list.”

Quality is the Top Priority.

HITECH Funding and Grants

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6With the increasing possibility of variable payments based on performance, children’s hospitals must look ahead three years and beyond to be ready for the fi nancial implications of health care reform.

“Reductions in government program reimbursement could be followed by reductions in insurance reimbursement,” Perkins says. “At Children’s, we’re creating ‘impact calculators’ with our industry peers to better understand how performance-based variables can affect our short- and long-term fi nancial futures.”

Even hospitals that prove their value through performance will likely face reductions. If more children are covered by Medicaid, pediatric hospitals can anticipate increased patient volumes and decreased reimbursements. At the same time, DSH payments will be reduced over a 10-year period — and eventually eliminated.

To do more with less, Children’s stresses “wise use of resources” each and every day. LEAN and Six Sigma methodologies are utilized to fi nd new ways to improve productivity.

“We constantly look for ways to control costs that do not diminish quality,” Perkins says. “But we will continue to look even harder.”

Hospital watchdog groups and insurance payors will keep an even closer eye upon hospital charges and outcomes, comparing effectiveness of one facility with another. The idea behind this renewed emphasis on transparency will be enhanced quality and reduced costs.

“We already consider ourselves to be transparent,” Perkins says. “We have and will continue to share quality and cost data with The Joint Commission and The Leapfrog Group, a national health advocacy group whose voluntary survey is considered the gold standard for safety, quality and cost comparisons.”

Additionally, a new section on the ChildrensOmaha.org website is dedicated to reporting key quality indicators, including patient satisfaction scores.

Perkins cautions against equating procedures performed at pediatric medical centers with those performed at adult hospitals. “You can’t lump us all together like that. We have experience and expertise caring for children that far outweigh a simple cost comparison.”

Reform may lead to hospitals being penalized three times for the same instance of a hospital-acquired infection: by the Centers for Medicare and Medicaid Services; through a value-based purchasing program (incentive funding based on performance); and through a stand-alone infection policy.

“At Children’s, our emphasis is always on prevention,” Perkins says.

Guidelines are already in place to reduce the incidence of central line infections, and to track and halt different infections using real-time information provided by Children’s electronic infection surveillance dashboard. Children’s has also implemented an aggressive and well-monitored hand hygiene program. Compliance to date is exceeding national standards.

Recognize Financial Implications.

Do More with Less.

Transparency Matters.

Reduce and Eliminate Infections.

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87Educating families about new coverage options will be a key factor in reducing the number of uncompensated care cases.

At Children’s, fi nancial counselors and registration staff routinely work with families to determine appropriate eligibility. A state representative is on-site to assess eligibility for Medicaid and other programs.

“We think we do a very good job helping parents explore payment and coverage options,” Perkins says. “Our experience with these situations is going to be even more important moving forward.”

Potential reimbursement reductions must be offset by proper coding, better charge capture, appropriate billing, timely collections, restrained supply costs and improved processes.

Again, Children’s is ahead of the pack in many of these areas.

“We’ve consolidated billing operations, benchmarked our revenue cycles and related services, and achieved greater effi ciency by implementing productivity measures used by our billing and customer service staffs,” Perkins says. “We keep a close watch on our supply chain through group purchasing plans and our use of Surgical Information Systems to manage and coordinate supplies and services.”

Assist Patients in Accessing Coverage.

Maximize Revenue Cycle, Productivity.

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9 10There will be increased consideration of Accountable Care Organizations (ACOs), and the replacement of fee-for-service payments with coordinated delivery systems that “bundle” charges for major procedures rather than bill for each individual service. ACOs are complex systems involving care networks, payor partnerships and infrastructure.

“Pediatric ACOs are still in discussion stages,” Perkins says. “Right now, we’re evaluating the challenges and weighing all our options.”

Children’s long ago recognized the value of physician alignment, Perkins says.

Support of Children’s Physicians, a group practice consisting of board-certifi ed pediatricians providing primary care, has yielded a key referral partner for hospital and specialty services at Children’s. The development of Children’s Specialty Physicians effectively joined together the specialists employed by Children’s and the pediatric specialists of the UNMC (University of Nebraska Medical Center) Physicians group practice.

“When you speak about physician alignment, you’re really talking about a coordinated continuum of care, from primary care to specialty, to hospital, to post-hospital, back to primary,” Perkins says. “Our work to date has produced a much stronger coordination and collaboration in that continuum of care.”

Examine the Potential for ACOs.

Physician Alignment

Though many aspects of health care reform have yet to be defi ned, and while the debate seems to focus on adult care, Perkins says one thing is certain: Children’s will do all it can to be prepared.

“No matter how the rules are changed, the goal remains the same,” he says. “The children we care for must come out on top.”

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to Save LiveSTHEy HavE juST arrivED fOr wOrk wHEN MEMbErS Of THE CriTiCal CarE TraNSpOrT

TEaM aT CHilDrEN’S HOSpiTal & MEDiCal CENTEr rECEivE THEir firST Call. iN a

SMall rEgiONal HOSpiTal wEST Of OMaHa, a MOTHEr iS SOON TO DElivEr a baby

THaT iS kNOwN TO HavE a SEriOuS HEarT DEfECT. ONCE bOrN, THE baby will NEED

EMErgENCy SurgEry — aN OpEraTiON THaT THE pEDiaTriC CarDiaC SpECialiSTS aT

CHilDrEN’S arE bEST qualifiED TO pErfOrM.

Racing

1.201114

to Save LiveS

The transport team, which includes a registered nurse and a nurse practitioner, each trained in emergency transport care and skilled in pediatric and neonatal critical care, hurries to the ambulance outside. Exclusively for use by the Children’s transport service, the brightly-colored ambulance is the only one of its kind in the area specially equipped for neonatal and pediatric patients.

The nurses check their watches. They didn’t even have a chance to take off their coats. The coffee they had hoped to be sipping will have to stay warm until they return.

There is no typical day for the Critical Care Transport Team. But there are many busy ones.

In 2006, Children’s introduced its neonatal transport team for newborns and infants up to two months old. Recognizing a growing need for specialized transport care, Children’s in the fall of 2009 expanded the program to include pediatric transport for older children.

“We really weren’t sure what our numbers would be when we began pediatric transports,” recalls Robert Chaplin, M.D., Medical Director of the transport service. “Our goal was to increase the number of trips approximately 10 percent to 15 percent each year.”

The service has exceeded all expectations. In 2009, the team responded to 216

transport calls. Last year, the number surpassed 600.

The numbers for 2011 continue at an amazing pace. The record for one month was set in March with 105 transports, surpassing the previous record set in February with 91 transports in only 28 days.

“To more than double our number of trips in one year, and to see those numbers continuing to rise, clearly illustrates the need,” Dr. Chaplin says.

Although routinely staffed by a registered nurse, a nurse practitioner, and a driver, the transport team can include a critical care physician when necessary. Calls requesting the service come from physicians, hospitals and emergency

raTHEr THaN waiT uNTil a SiCk baby iS bOrN, THE TraNSpOrT TEaM iS OfTEN CallED

iN aDvaNCE TO bE prESENT aT THE MOMENT Of DElivEry. THaT way NOT a SECOND iS

waSTED gETTiNg THE TiNy NEwbOrN aS quiCkly aS pOSSiblE frOM THE DElivEry rOOM TO

CHilDrEN’S, wHErE lifE-SaviNg CarE iS rEaDy aND waiTiNg.

1.201116

departments in Nebraska, Iowa, Kansas, Missouri and South Dakota.

Children’s partners with American Medical Response to provide ground transportation. The farthest the team has traveled by ambulance was 182 miles to O’Neill, Neb.

In July 2010, Children’s joined with LifeNet, in association with AirMethods Corp., to provide helicopter service. This year, the transport service is adding the availability of fixed-wing aircraft.

“More and more physicians in town and around the region are seeing the advantage of having a dedicated pediatric team to transport their sickest children to Children’s for care,” Dr. Chaplin says. “The kind of critical care we provide even before a patient reaches our door can dramatically improve the outcome.”

At the hospital west of Omaha, the transport team arrives in time for the birth of the baby with a serious heart ailment.

“Our team worked with the delivery team to quickly stabilize the baby and transport him back to Children’s for surgery,” Dr. Chaplin says. “The team took him directly into the Cardiac Catheterization Suite, where he underwent the first procedure necessary to treat his heart condition.”

The following week, the baby had improved enough to undergo definitive

surgery to correct the heart defect and put him on the road to recovery.

“Our transport nurses are fully trained in cardiac medicine as well as Extracorporeal Membrane Oxygenation (ECMO) support,” Dr. Chaplin says. “They were able to prepare him for the emergency surgery while en route to our hospital, reducing delays that could have proved fatal.”

Barely an hour passed when the next call came in. A 13-year-old girl about 100 miles outside of Omaha had been brought to her local hospital complaining of a headache and flu-like symptoms. The physician attending her finds her heart rate to be extremely high and is concerned enough to request the transport team from Children’s.

The team is back in the ambulance and on the way.

Rebecca “Becci” Meredith, R.N., has been a part of the transport team since its inception. A veteran of service in both the Pediatric and Newborn Intensive Care Units at Children’s, she is certified in pediatric critical care and pediatric & neonatal critical care transport, and trained in ECMO support — skills and experience that distinguish members of the transport team.

There’s one other quality that Meredith says gives her an edge when it comes to knowing how to calm and comfort sick babies and children.

She’s a mom.“I think being a mother makes me better at what I do,” she says. “I know the movies kids like; the songs they like. I’m trained to care for their medical needs when they are very sick, and when they’re frightened, I know how to talk to them and make them feel more secure.”

Caring for children on a regular basis instills a familiarity with pediatric medical issues that are rare at adult-care facilities.

“Because we work with kids, we can walk into an exam room and very quickly assess how sick the child is,” Meredith says. “Some of them just need us to hold their hand and talk along the way. With others you just hope we can hurry enough to get them to Children’s.”

Once the team examines the child, one nurse usually collects vital information while the other concentrates on care. There are times, however, that the child is so sick both nurses must immediately provide care.

“We can usually communicate what we need to do with just a look to each other,” Meredith says. “We know when we have to act fast.”

Speed is essential when the team reaches the 13-year-old girl with the high heart rate. She has gone into shock and is slipping in and out of consciousness.

“they weRe abLe to pRepaRe him foR the emeRgency SuRgeRy whiLe en Route to ouR hoSpitaL, Reducing deLayS that couLd have pRoved fataL.”RobeRt chapLin, m.d.

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“When our team first assessed her she was barely conscious and looked extremely sick,” Dr. Chaplin says. “They immediately recognized she was in shock and needed therapy right then.”

The team inserts an IV and begins administering fluids to combat the shock, then antibiotics to help stabilize her for transport.

“By the time the team had all of the initial resuscitation measures completed and was ready to leave for Children’s, the girl was awake and answering questions, even interacting with her very scared parents,” Dr. Chaplin says. “Our team was able to explain the problems to her family and even brought her mom in the ambulance to Children’s.”

As her condition improves during the ride to Children’s, the teen and her mother grow more reassured with every mile that passes. After being hospitalized for about a week to treat a dangerous bacterial illness, she is able to continue her recovery at home.

Critical care nurse Becci Meredith says the region’s small rural hospitals “truly do a fantastic job in emergencies, but they see so few sick kids on a daily basis that they don’t have the pediatric skills we can provide.

“Once we walk in the door, that child is in the care of Children’s Hospital & Medical Center. I know that saves lives.”

The Children’s transport team affords immediate access to the only dedicated pediatric hospital in the state. Dr. Chaplin says that expertise can have a profound impact upon care, whether the child is fifty miles or only five minutes away.

Like the two-month old boy who had been taken to an emergency department at an Omaha adult-care hospital suffering from a fever and extreme fussiness. The baby’s condition worsened rapidly, and despite their attempts, the attending medical personnel are unable to start an IV or insert a tube into the child’s airway (intubate) to prevent the airway from collapsing.

So they call for the Critical Care Transport Team from Children’s.

“When we arrived, we found they had been unable to intubate the child and were having to breathe for him,” recalls Dr. Chaplin. “We were able to secure the child’s airway with a breathing tube and administer sedation, even before IV access was obtained.

“The team then established an IV via the child’s leg bone to administer the IV fluids and antibiotics he needed to combat the severe shock.”

The team stays with the infant in the emergency department until he starts showing improvement.

“Once he had stabilized, we were able to safely transport him to Children’s for further evaluation and management,” Dr. Chaplin says.

At Children’s, tests determine the infant has a bacterial infection. After several days of IV antibiotics, the baby recovered.

Dr. Chaplin says the incident further illustrates the importance of having medical personnel present who are skilled at treating very small children.

“Whether it’s on the ground or in the air, we have the equipment and therapies these children need immediately, and the knowledge to administer this care en route,” he says. “Along the way, our teams can be in constant contact with our intensive care physicians, surgeons and cardiac specialists.

“Once they arrive at Children’s, we offer immediate access to specialists and subspecialists that other hospitals don’t have.”

One very busy day. Three transport calls, each posing a unique situation best handled by experts who know and care for sick children every day of the year.

There’s nothing typical about that.

“we can uSuaLLy communicate what we need to do with juSt a Look to each otheR. we know when we have to act faSt.”Rebecca “becci” meRedith, R.n.

For transport nurse Kim Goracke, bringing young patients to Children’s Hospital & Medical Center isn’t a job, it’s a passion. Goracke is the recipient of the 2011 Robert E. Murphy Spirit of Caring Award.

The award honors the legacy of pediatrician Dr. Robert E. Murphy. Created by his family, it recognizes a pediatric nurse at Children’s who exemplifies those qualities that provide comfort and support to children and their families during a hospital or clinic experience.

Goracke possesses superior nursing knowledge and skills. She has earned three separate specialty certifications: High Risk Neonatal Nurse, Critical Care Nurse, and Neonatal-Pediatric Transport Nurse.

She also demonstrates an unparalleled commitment to patients and families, reaching out with a compassionate spirit that both amazes and inspires. After arriving at Children’s with a critically ill child, Goracke noticed the patient’s mother had come without shoes due to the urgent nature of the situation. Goracke, wearing her flight suit and boots, grabbed her own shoes and gave them to a grateful mom. The true spirit of nursing in action.

Spirit of Caring

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MasterMind

At a passing glance, there’s nothing magical about the charcoal gray building with the narrow row of windows and silver doors, tucked anonymously among the varied businesses at 37th and Leavenworth Streets.

Inside is a different story.

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Matthew placzek

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It’s the story of Omaha sculptor Matthew Placzek, a tale where the slightest of dreams are transformed by talent and skill into works of art on a grand and glorious scale.

Ask him how he does it and instead he’ll tell you why.

“I think you must evolve as an artist,” he says. “That’s why I want to be creating something new every day.”

A Nebraska native, Placzek was born in Columbus and reared in Grand Island, where he was captivated by waterfowl along the Platte River. He began drawing and painting, but eventually became attracted to the three-dimensional challenges and opportunities of wood carving.

“I sold my first piece for $20 when I was 14; it was a duck decoy,” he recalls. “That’s all it took. I was hooked from then on.”

He studied art at Hastings College and Creighton University, now home to his sculpture, “Billy Blue Jay.” Prolific in dedication and imagination, his works are part of corporate collections and permanent exhibits stretching from Beverly Hills to London, Vienna, Prague and Tokyo. He is represented by galleries in Florida and Arizona, and at Borsheims in Omaha.

About 12 years ago, Placzek gravitated from smaller works toward large-scale sculpting. In 2003, he was commissioned to create “Labor” for Lewis & Clark Landing along the Missouri riverfront.

“For ‘Labor,’ I was inspired by the sculptor Rodin and his exaggerated forms,” Placzek says.

The result is a 30-foot-tall, 271-ton steel, bronze and concrete depiction of massive iron smelting ladles and the workers who utilized them at a plant once situated at nearly the same spot along the river.

“My transition into the larger scale happened at a good time,” he says. “Gallery sales tend to reflect the economy, and the economy had slowed.”

He continued creating sizable works: the playfully abstract “Illumina” outside Omaha’s arena and convention center, “The Protector” firefighters’ memorial not far from “Labor” along the riverfront, and “Sioux Warrior” at the Joslyn Art Museum.

As plans were drawn for the Specialty Pediatric Center at Children’s Hospital & Medical Center, the architects at HDR Inc. who designed the facility recognized the need for a showcase sculpture. They approached Placzek and shared their desire

for a large work to be placed on private property yet still be very much a public display, considering the high volume of traffic that passes the corners of 84th Street and West Dodge Road each day.

“They wanted something spectacular,” Placzek says. “I can do spectacular.”

So he created “Imagine,” the graceful, fun sculpture that enlivens the northwest corner of the new building. The work was a gift to Children’s, paid for by private donors, foundations and area corporations.

Visually stunning no matter the time of day, “Imagine” begins on the lawn outside the building with five larger-than-life sculptures of children playing with umbrellas. It continues into the glass-enclosed stairwell, where 19 umbrellas rise 75 feet along a stainless-steel ribbon.

“I wanted lots of action, tons of movement,” he says, “lots of happy children expressing the simple joy of playing with an umbrella.”

Light, color and movement figure highly into Placzek’s works. “Illumina” at the convention center, for example, features musicians and brilliant carnival figures, some holding lighted spheres. The beautiful series “Metamorphosis” outside

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the Butterfly Pavilion at the Henry Doorly Zoo depicts the life cycle of a butterfly in aluminum and acrylic panels that seem to radiate in sunlight.

For “Imagine,” Placzek wanted to capture both natural and artificial light.

“We developed a system where the LED light is refracted off the umbrella, creating a light box,” he says. “The outside is coated with metallic paint, so during the day you still see something. At night, the metal seems to disappear.”

The umbrellas, weighing nearly 200 pounds each, contain programmable LED lights capable of emitting more than 16 million color combinations.

Placzek says he had been toying with the idea of incorporating umbrellas into a work well before “Imagine.”

“I thought it would be neat to have a piece with figures doing something with umbrellas, and have them floating away,” he says. “The staircase proved to be the perfect venue, and being part of Children’s Hospital & Medical Center, I wanted to convey nurturing, hope, caring and safety.

“What figured into my design was imagining a family with their world

turned sideways, coming to Children’s, not knowing what was going to happen. When they see the bright umbrellas during the day, or the bold colors at nighttime, maybe it will take their mind off things for a few minutes. And if they can find joy in the piece, then I’ve been successful.”

Placzek shares the ample display space at his Leavenworth Street studio with his artist wife, Kimberly (Kushner), whose talent as a painter is immediately obvious.

The two met on a blind date arranged by a decorator and friend of Placzek who was working at Kimberly’s mother’s home. Now married for 21 years, they have an ideal, complementary relationship. “She is my support system,” he says. “When I work on a new piece, I’m always excited to show her. She sees things I don’t.”

They have three children: Aaron, 18, studying business at Indiana University; Noah, 16; and Phoebe, 13, students at Westside High School. “Each of them is artistic in their own way,” he says proudly. “They’re extremely bright

kids. They have the math and science skills their mother and I lack.”

Any deficiencies in those subjects are overcome by Placzek’s seemingly limitless creativity.

Rather than bronze or steel, most recently he has been playing with brightly-colored acrylic sheets, cutting them into different shapes, twisting and shaping them around a light source. He’s not quite sure where he’s going with it. For now, moving forward is enough.

“You have to continually create something for yourself. It pushes you along.

“If I didn’t do that,” he says, smiling, “I’d still be carving ducks.”

“they wanted something spectacular. i can do spectacular.”

23

Solid Past, Bright Future

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It’s only natural to be concerned by the potential changes health care reform may bring. Right now, there are more “what ifs” than answers.

But we shouldn’t be frightened.

Why? Because some of the changes being discussed are simply good business. Some are much needed to repair things broken within the system. Some are intended to ensure quality and access to care. And some reforms will probably never see the light of day.

Regardless of what finally emerges from the great health care debate, I think Children’s is well-positioned to weather any storm of new regulations and continue its mission. After all, we’ve been implementing good business practices since we opened our doors 63 years ago. We’ve taken steps to utilize our resources — people, ideas, equipment and funds — in the most prudent manner possible. We take great pride in delivering the highest quality care, and in making it available to all children, no matter their ability to pay. We’re doing a good job, and we’re constantly looking for ways to do better.

Secondly, Children’s is an asset to the community. In Omaha, in our state and throughout the region, our reputation as the source for top-quality health care for children is both known and deserved. Our physicians, nurses, and support personnel are among the most highly-trained and experienced caregivers in the nation.

They are experts in treatments and new techniques, and as you learned elsewhere in this issue, the research they are conducting is having a positive impact on pediatric care around the world.

Another good reason not to fear pending reforms is the growing need for independent children’s hospitals in general, and the real need for Children’s Hospital & Medical Center in particular. When your lawnmower breaks down, you don’t take it to your neighborhood auto mechanic. That’s because one engine isn’t the same as all others. The same is true of hospitals. Many adult hospitals have added their own pediatric units. But they don’t see many young patients, and they don’t specialize in treating and curing kids like we do at Children’s. I’m a firm believer in the idea that the more you do something, the better you are.

The specialized care we offer is strengthened by our affiliation agreement with the University of Nebraska Medical Center College of Medicine. It makes us more than a care facility. We are a full-service, free-standing, non-profit, children’s academic medical center. The brightest students come here to learn from the smartest pediatric medical professionals around.

There is a real possibility that health care reform may result in the resources we have being stretched even thinner. More children seeking care may prompt more adult hospitals to start or expand

their own pediatric services. However, recruiting pediatric sub-specialists to their own facilities would expose the most vulnerable of children to competition that is not in their best interest. This harmful fragmentation could push specialty services beyond their limits.

Children aren’t small adults. They have unique medical needs that are best treated by those who know children. And there is no doubt in my mind that Children’s Hospital & Medical Center, and other dedicated, independent children’s hospitals, are the most qualified places to meet those needs.

Yes, I am concerned by the uncertainty that lies ahead. I’m also confident that Children’s will continue to do whatever it takes to provide the best pediatric care available.

That is a fact we can all find comforting.

Commentary by Gary A. Perkins, FACHE President and CEO Children’s Hospital & Medical Center

personal and small group visits offer unique insight into Children’s Hospital & Medical Center. past guests have included Senators Mike johanns and ben Nelson, and Congressmen lee Terry and adrian Smith. we’ve also welcomed state legislators and community partners, as well as visiting physicians from russia and israel who selected Children’s as a pediatric model; one of a select few children’s hospitals each group visited during a trip to the united States.

Seeing is believing. whether it’s a peek inside Children’s Newborn intensive Care unit where the tiniest of patients overcome the biggest challenges, or a glimpse of a cutting edge procedure inside Children’s state-of-the-art hybrid pediatric heart catheterization lab, guests experience for themselves why ‘we know children.’

BEHIND-THE-SCENES

Seeing is believing.

andy kuchta and son Daniel, a NiCu patient, with u.S. Congressman adrian Smith (r-NE).

ChildrensOmaha.org