REBUILDING

REBUILDING
The story of Mercy in Joplin

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© 2012 Mercy. All rights reserved.

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Table of Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Five hospitals, continuous care . . . . . . . . . . . . . . . . . . . . . . 7 A closer look | Demolition sets stage for rebirth . . . . . . 17 Why rebuild? It’s the Mercy way . . . . . . . . . . . . . . . . . . . 21 A closer look | The recovery takes root . . . . . . . . . . . . . 30 New hospital leads the way . . . . . . . . . . . . . . . . . . . . . . . .34 A closer look | Mercy mission: Beyond a hospital . . . . 44 About this series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

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A direct hit
Sunday, May 22, 2011, at 5:41 p.m. A twister strengthens into an EF5 just as it tears into St. John’s Regional Medical Center. At the hospital, 117 co-workers rescue 183 patients. Five patients and one visitor die.

W t St W. 7th St.

Joplin
F H O PAT

E 7 h St E. 7th St.

ADO TORN
E. 20t St. 20th

W. 20th St.

E. 32nd St. S. Main St. S. Duquense Rd.

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71

S. Range Line Rd.

0

N
Mile le l

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TORNADO STRENGTH

EF0 86

EF1 111

EF2

EF3

EF4

EF5 200+

136 166 Winds in mph

The storm kills 161 people and destroys 8,000 structures, including 7,000 homes.

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Preface

T

he deadliest U.S. tornado in modern times descended on Joplin, Mo., in May 2011. Winds churning at 200 mph leveled nearly every home, school and business in a path six miles long and nearly a mile wide. Amid the destruction stood the ruins of St. John’s Regional Medical Center, a part of Mercy since 2009 and whose nine stories of shattered windows and crumpled metal became an iconic image of the broken city. For 90 minutes, Mercy co-workers and volunteers evacuated 183 patients from their rooms, carrying them down dark, debris-strewn stairs to safety. The people of Joplin have fought to recover and rebuild their Midwestern homeland. In their progress emerge tales of inspiration and hope. The Mercy hospital is one, a story that reaches across medicine, faith and community. Just days after the storm, Mercy leaders heartened the battered community with a promise to build a new hospital, now expected to open in 2015. A week after the storm, the ministry established a tent hospital, months later replaced it with temporary structures, and the following spring built a full-service hospital in record time with groundbreaking component technology. Now called Mercy Hospital Joplin, the life-saving organization will have occupied five structures in less than four years. The ministry will have invested nearly $1 billion in Joplin buildings, and in its people by continuing to pay 2,200 Mercy employees. Mercy moved decisively because it is committed to the community and to the legacy of the Sisters of Mercy, whose care for those in need led to Joplin’s first hospital in 1896. This is the story of Mercy’s rebuilding in Joplin.

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Five hospitals, continuous care

E

ven as their staff cared for patients and co-workers in the tornado’s aftermath, Mercy leaders wondered what to do with their wrecked hospital — and how to provide the quality care for which St. John’s Regional Medical Center was known. Within days, Mercy announced it would build a new hospital. But that would take years. The ministry needed to provide for patients, co-workers and the region until then. What it did would not only differ from anything Mercy had ever done. It would differ from what anybody had ever done.

Left: The tent hospital was a network of arched, white canvas tunnels with rooms divided by curtains.

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The five hospitals
1
ORIGINAL CAMPUS
Destroyed by tornado
Medical offices

Main hospital

Temporary doctors’ offices Brady Rehab Center
D. BLV AND
S

VD BL

.

LELL

McC

Mercy Discovery Center (day care)

Hospital complex Main building and nearby clinics and offices are destroyed.

1

Tent hospital Within a week, a military field hospital is up and running a block away.

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Modular buildings By fall, portable buildings replace the tents on the same lot.

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2011

2012

ST .J

OH

N’

2013

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TEMPORARY CAMPUS
28TH STRE ET

2& 3
Tents and modular buildings Mercy Village (retirement community)

Mercy Hospital Joplin

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Mercy Hospital Joplin Eleven months after the storm, the hospital reopens in a structure built with ground-breaking technology.
Entrance Lab Imaging Cafe Pharm. Operating rooms/ cath labs

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Future Mercy Hospital Joplin A new hospital is scheduled to open three miles from the original site. Joplin
PAT
O Original hospital

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TORNAD H OF O
71 44

Emergency

ICU

Patient wings (2 stories)

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2014

N. St

Future hospital

2015

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‘I’m fine here’ First came a military tent, which was renamed St. John’s Mercy and which the co-workers later took to calling “Mercy M*A*S*H.” The offer for an 8,000-square-foot field hospital came from nearby Branson, where a state disaster team had erected the 60-bed tent in an earthquake drill. The tent raised concerns for Lynn Britton, Mercy’s president and chief executive officer, who had arrived on the scene the day after the tornado. But he realized that Mercy had few options. “Sure, let’s go take a look,” he said, and drove the 90 minutes to Branson with Mike McCurry, Mercy’s chief operating officer, and Dottie Bringle, chief nurse at the Joplin hospital. As they stood looking at the tent, McCurry turned to Bringle. “So?” he asked. “You think you can turn this into a hospital?” Bringle didn’t hesitate: “You betcha.” The return drive allowed time to sketch out a rough design, led in good part by Dr. Bob Dodson, the hospital’s chief of staff. By 1 a.m. on Thursday, only days after the storm, the tent stood in the parking lot across the street from the emptied hospital, erected by the National Guard and Missouri’s Disaster Medical 1 Assistance Team. Ten arched sections comprised the tent hospital, with a common area linking them. Mercy had to figure out the electrical service, plumbing and where new equipment would come from to fulfill Dodson’s plan. Co-workers arrived to help with setting up, using local contractors when they could. Mercy structural engineers from St. Louis and elsewhere joined the effort.

Original building

Besides the much-needed beds, the tent included a small emergency department, a pharmacy and mobile surgical units. More sophisticated departments, such as obstetrics and heart surgery, would have to wait. “We were designing on the fly,” says John Farnen, a Mercy leader who helped oversee construction.

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Mercy co-workers prepare for the opening of the tent hospital.
Aaron DuRall - DuRall Photography

Much of the equipment came from Mercy’s other hospitals. “If we had been a standalone hospital, we would have had nothing,” says Shelly Hunter, the hospital’s chief financial officer. Communications remained spotty, with cell phones working sporadically. Finding a colleague to talk face-to-face was often the only choice.

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Tents On Saturday, the fire marshal gave his OK, and the hospital opened at 7 a.m. that Sunday, with Mercy’s electronic health records helping ensure seamless patient care. The first patient arrived at 7:03, less than a week after the tornado struck.

“We worked like crazy to get that up,” Bringle recalls. “We were exhausted; we were running on adrenalin. Everybody felt a major sense of accomplishment.”

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Even as they readied the tents, Mercy’s planners considered how they could house doctors’ offices. They set up modular clinics in nearby portable buildings. The hospital’s lab went into a Winnebago trailer. As temperatures outside approached 100 degrees, the staff worked furiously to keep it cool enough inside to protect sophisticated equipment. Mercy, meanwhile, bought a drug treatment center in Joplin and eventually converted it to a 30-bed facility for behavioral health patients. The tent hospital presented a marketing challenge, to say the least. “It was difficult to get people to understand they could even go and get care there,” says Dick Weber, a Joplin businessman who serves on the local Mercy board. Some patients didn’t need convincing. They had been treated at St. John’s their whole lives and didn’t want to go anywhere else. One was the mother of Rob O’Brian, president of the Joplin Area Chamber of Commerce. In her 80s, she insisted on going to the tent hospital after suffering a fracture in a fall. She would stay a week, with summer temperatures rising and the roar of air conditioning units outside her “room.” At one point, nurses asked if she would be more comfortable elsewhere. “I’m fine here,” she told them. “This is the place I go to and I’m perfectly fine here.” O’Brian says his mother’s care didn’t suffer under the conditions. “The level of care provided even in those difficult circumstances — it was the same.”
Moving to ‘The Ritz-Carlton’

Mercy knew that as winter came, patients would need something warmer. By now, Dr. Glenn Mitchell had stepped forward. A career Army medical administrator, Mitchell brought invaluable experience in quickly deploying mobile hospitals, including after disasters such as 1998’s Hurricane Mitch in Central America. He helped lead Mercy executives to a Michigan company that made modular buildings of Styrofoam compressed between sheets of metal. While

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While still temporary, the hospital comprised of portables was quieter and less crowded than the tents.

the company had never built a full hospital, its portables slowly replaced the tents throughout the summer and early fall. Primitive by conventional standards, the hospital seemed a big leap for Mercy’s co-workers. “It felt like we were at the Ritz Carlton,” says Missy James, a nurse manager.

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Inside the portables In early November, when it was finished, one co-worker asked Sister Cabrini Koelsch, the hospital’s ministry liaison, to bless the new structure. When the Sister arrived, the worker showed off a new feature for which she was especially grateful. “Sister, we’ve got flushies!” she said, referring to the full toilets that replaced portable versions that accompanied the tent.

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An eight-month miracle As contractors installed the portables, Mercy planners thought ahead, pushed again by the weather. The portables would suffice for winter, but nobody wanted patients in trailers when spring storms returned. Engineers considered alternatives, and Mercy solicited bids from several companies, choosing a California firm with a factory that builds component structures. As Mercy readied the site, the contractor began fabricating 224 modules of the same steel, concrete and drywall found in conventional construction. Essentially large slices of 4 a building, modules reached 14-feet wide and high, and up to 60-feet long. Shipping them cross-country raised tough challenges, with a few units traveling by train and most on trucks cautiously navigating roads that suddenly felt narrow. Some modules arrived more than 80 percent complete, as local workers waited to join them together and stitch in the Module en route necessary plumbing and wiring. Early on, Mercy leaders considered the “component hospital” a temporary structure. But as it took shape, interior and exterior touches smoothed the slices into a hospital that looks no different from any other. A consensus emerged that the sturdy and goodlooking facility should be called nothing other than Mercy Hospital Joplin, with its 150,000 square feet of space, a full-size emergency department and room for 100 overnight patients. Instead of

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something temporary, the structure may have a long-term role at the site, says Britton, Mercy CEO. “It’s a building that could serve Joplin for decades to come.” The largest acute care facility built with modular construction, the Mercy hospital is twice as large as any the California contractor had fabricated before. Mercy brought in its own roofing consultants and other quality control specialists to ensure it would meet the ministry’s standards. Room also had to be made in the factory for state and local inspectors who wanted to see the modules assembled. Hundreds of workers labored tirelessly, many pulling double shifts to get the hospital in place. At one point, 150 electricians scrambled past each other as they pulled wire through the state-of-the-art facility. “You go until you get done,” says Andy Bowers, of Neosho, Mo., one of 300 local workers hired for the project. He recalls that one day after it rained, workers tracked red clay down the hallways while others followed, cleaning up behind them. “People are everywhere,” Bowers said during the final rush to finish. No one welcomed the component hospital more than the medical personnel who had practiced in tents and trailers. “It’s a wonderful thing,” says Dr. Charles Ro, a surgeon who moved to Joplin two years ago. He notes that

New interior

Mercy Hospital Joplin came together quickly using pre-fabricated components transported by tractor trailer.

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the hospital allows for sophisticated procedures, including a resumption of open-heart surgeries. It also brings back a Mercy obstetrics unit that reassembles co-workers scattered across Joplin and elsewhere, says Kathy Cowley, a nurse who manages the unit. “And we get to start delivering babies again.” Along with its new challenges for his company, the project has brought an added level of satisfaction, says founder Charlie Walden of the California contractor, Walden Structures. He’s sensed what he called a devotion of Mercy co-workers and their commitment to Joplin. “There’s a feeling you’re adding back to the community.” Mercy opened the new hospital to tours in early April and to patients by the middle of the month. “To get all that done in eight months is remarkable,” Farnen says. The effort by Mercy co-workers and contractors was nothing less than a marvel, aided by good weather and what hospital President Gary Pulsipher calls the “Mercy Machine” from across the region. “We wouldn’t have been able to do any of this without the help of the rest of Mercy. Everyone at Mercy stood up in a way that surprised us.”
5 The future

Future hospital

Mercy’s next and greatest challenge is already underway: Building another hospital big enough to fully replace St. John’s. Mercy broke ground in January 2012, just as its leaders had promised in those dark days after the tornado. It will carry forward the new name, Mercy Hospital Joplin.

At the groundbreaking, dozens of Mercy co-workers and their families showed up with shovels. They hugged as they celebrated the beginning of a new hospital and their accomplishments of the previous months. And for Farnen, it marked the end of juggling multiple, consuming projects needed to restore Mercy to Joplin. “Building just one hospital — it’ll feel like a break.”
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A CLOSER LOOK

Demolition sets stage for rebirth
It took minutes for a tornado to knock St. John’s hospital out of commission. It will take a year to demolish what’s left and remove the rubble. Mercy co-workers and contractors are taking care to prepare the roughly 50-acre site in the heart of Joplin for a rebirth that will leave the community even stronger. The winds that tore through the campus blew out windows and tossed equipment blocks away. Some paper records landed near Springfield, Mo., 75 miles to the northeast. Structurally, the 750,000-square-foot building held up better than could have been expected. But everything inside was wiped out — walls, windows, stairwells. There would be no keeping out moisture, and with it, mold. Mercy leaders quickly determined the damage made it too costly to gut and retrofit the building. They would instead build a new hospital at the city’s southern edge.

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Meanwhile, Mercy wanted to erase “the visible signs of the tornado’s devastation from the landscape” and prepare the site for a brighter future, says Gary Pulsipher, president of the Joplin hospital. That revival began at the south end of the property, where several medical buildings stood near the main hospital. Workers began the demolition there to make room for a new elementary school. Mercy is donating 12 acres to help Joplin replace classrooms wrecked by the storm. Other parts of the site might become a theater, a small woods and memorial gardens to lives lost in the tornado. Community members, starting with a open meeting that evolved into an advisory board, are working with Mercy leaders to ensure the results will respect and honor the site’s role in Joplin’s history of growth and resilience. The campus literally stands atop a part of that history — a matrix of underground lead mines. The Joplin area was known as the lead mining capital of the world beginning in the 1830s. In more recent times, the mines were filled in to make way for commercial growth, which included construction of the medical center in 1968. Under normal circumstances, demolition experts would implode the main hospital. Because of the mines, experts feared explosive charges might generate “uplift” pressure that could damage neighboring properties. So contractors turned to a traditional wrecking ball and specialized grappling equipment to finish off the building. Mercy held a ceremony of remembrance and appreciation in January 2012, with a bagpiper playing Amazing Grace as a crane took its first swings with the ball. That it took seven months to get to that point would come as no surprise. In its own way, untangling a destroyed hospital is as delicate as the microsurgery once conducted there. When Mercy co-workers returned to the scene after the tornado, they donned respirators, hazardous materials suits and boots. For nearly two months, workers sifted through materials found in the ruins, including office furniture, medical equipment, medications, computers and financial records. At one point, small refrigerators that had held medicines lined up shoulder-to-shoulder in the parking lot awaiting disposal. Fortunately, patient files stayed
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Courtesy: Eric Rudd

Cross-town journey: A Missouri State Highway Patrol truck carries a wooden cross from the debris-strewn emergency department (left) to the groundbreaking (top right).

safe in powerful computers in Washington, Mo., the heart of Mercy’s electronic health records. Workers inventoried the material, much of which rests in a warehouse in Springfield. Amid the flotsam are Bibles, artwork and other decorations. Workers also found three time capsules — one from when the hospital was built, another when the east tower opened in the 1980s and one marking St. John’s 100th anniversary in 1996. During the demolition ceremony, workers loaded a 4-foot-tall cross from the emergency department onto a truck and carried it to another ceremony marking the start of work on a new hospital. Mercy will find a permanent and prominent spot for the icon, says Terry Wachter, hospital vice president for mission. “The cross certainly has scars on it,” she says. “They just add character.”
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Why rebuild? It’s the Mercy way

M

inutes after learning a tornado had pummeled Mercy’s hospital in Joplin, Mike McCurry heard comforting words from his boss and the head of the company, CEO Lynn Britton: “Mike, don’t worry, we’re going to rebuild.” It was a gut response, and for a steward of Mercy’s mission, a happy moment for the company and its ministry. “It’s very affirming,” Sister Mary Roch Rocklage, former CEO, says of how Mercy’s current leadership responded. “Somehow, they have the same calling — an attraction to serving in a certain way.”

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The impulse to stick with Joplin in its hour of need was a “nobrainer,” she says, for anyone steeped in the values and traditions of Mercy. Still, Sr. Roch’s smile grows wider as she talks about how the decision was made — not by the Sisters of Mercy who ran the health ministry for more than 135 years, but by the co-workers who assumed responsibility more than a decade ago. It’s also no accident. When the Sisters of Mercy gave up the day-to-day management of their hospitals and clinics, they worked to preserve the values that drove them in their health care mission. They maintain influence at the highest levels, including on Mercy’s board of directors, though members of the religious order are a minority. It’s the board that chooses Mercy’s top executives. “We’re very selective about who we hire,” Sr. Roch says. The Sister continues in an official capacity as health ministry liaison for Mercy, which now has more than 30 hospitals, revenue of more than $4 billion and 38,000 employees in more than 100 communities. As with other Sisters, her job essentially is to preserve within the organization the values and the tradition of the Sisters of Mercy. And a long tradition it is. The religious community that gave rise to St. Louis-based Mercy began with six nuns who arrived in 1856 from New York by train and boat. Their Catholic order originated in Ireland, founded in 1831 by Catherine McAuley, an orphan adopted into a wealthy Quaker home. She inherited a fortune. Near a wealthy part of Dublin, she opened the first “House of Mercy” that was dedicated to providing education and social services to the poor, with a particular emphasis on women and children. Church leaders agreed to a non-cloistered institute that allowed McAuley and her co-workers to become an unusual religious order, one that provided aid outside a convent. The odd sight of religious Sisters bustling about Dublin’s streets earned them the nickname, “the walking nuns.” The order’s “bias for

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Now health ministry liaison, Sr. Roch was Mercy’s first CEO in 1986.

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action” helped attract hundreds of women to join and remained a central tenet through the decades. The six nuns came to St. Louis to start a Catholic school. They soon saw a need for health care and by 1871 had opened their first hospital in St. Louis, which later became St. John’s Hospital, named for St. John of God, who had served the sick and poor in Portugal. Now known as Mercy Hospital St. Louis, the center is Mercy’s largest institution with nearly 1,000 beds. Another Mercy hospital in Springfield, Mo., has about 850 beds, and the Mercy hospital in Oklahoma City, Okla., nearly 400 beds. Most of Mercy’s hospitals landed in much smaller towns as the Sisters sought those with the greatest needs. Even Springfield was just a dusty country town when the Sisters of Mercy arrived in 1891 to start what became another St. John’s hospital. Most of the

In the beginning: The late-1800s groundbreaking for Joplin’s first Mercy hospital.

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Tough stuff, even today: Pictures of early Sisters of Mercy survived the tornado.

towns that drew the Sisters have remained relatively small. Mercy primarily operates across four states — Missouri, Oklahoma, Kansas and Arkansas — with nearly 30 smaller hospitals in towns like Lebanon, Mo., and its 60 beds; Independence, Kan., also with about 60 beds; Berryville, Ark., with 25 beds; and Healdton, Okla., with about 22 beds. Joplin sits near the geographic center of Mercy’s territory, serving as a commercial and health care hub at the border of Mercy’s four states. Joplin has only 50,000 residents, but the city swells every day to several times that size with those working, shopping, or seeking medical care. Like many of the Mercy hospitals, Joplin has a Sister of Mercy who focuses on the ministry’s commitment to serving the poor. “We want to pass on the heritage of Mercy — that we don’t turn

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anyone away for health care,” says Sister Cabrini Koelsch, director of mission services at Mercy Hospital Joplin. “That's part of who we are.” Thirteen of the nuns arrived in the summer of 1885 in Joplin, responding to yet another request to start a school in the rough-hewn mining town. The Sisters once again found a pressing need for health care. They opened a small infirmary in the 1880s, and in 1896 opened the ten-bed Mercy Hospital in a house donated by a local mine operator. Joplin quickly outgrew the small hospital and the Sisters raised money for a new hospital that opened in 1900 on the south side of town. The hospital kept growing through the 1950s, though old sections stymied the use of modern technology. The Sisters cast their eyes to a new location further south. A federal grant and local donations along with $1 million from the Sisters of Mercy themselves financed the new St. John’s Regional Medical Center. The marvel of a hospital opened in 1968 with 300 beds, an extended-care facility and high-tech systems that drew widespread attention. The hospital struggled financially in the 1990s and became part of another not-for-profit system that operated the center. Not long after, the Joplin hospital caught the eye of Mercy in St. Louis, which was developing a contiguous health care corridor that roughly follows I-44 southwest from St. Louis into Oklahoma and includes operations in western Arkansas and southeast Kansas. Mercy made two attempts in the late 1990s and early 2000s to acquire the Joplin hospital, recalls Ron Ashworth, chair of the Mercy health ministry. In late 2009, Mercy succeeded in gaining sponsorship of the hospital. As with many religious orders, the Sisters of Mercy have dwindled in number as fewer young women take vows of chastity, poverty and obedience. “Up until the 1950s, there were Sisters everywhere when you came to a Mercy facility,” says Sr. Cabrini. “Now there aren’t many Sisters left, so we turned our ministry over to our co-workers.”
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The I-44 corridor
= Mercy locations

MI SSO URI KANSA S
44

St. ouis St Lo

Joplin

OK LA HOMA
Oklahoma City

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A RKA NSA S

In the process, the Sisters sought to preserve the unique personality of their order in the work of Mercy. They identified the values that guided their work — dignity, justice, service, excellence and stewardship. They also gave voice to the order’s “charism,” a Greek word meaning the graces given to individuals for the good of others — bias for action, entrepreneurial, hospitality, right relationships and fullness for life. Its bias for action, in particular, seems to distinguish the order. As one priest liked to tell Sr. Roch, he could spot Sisters of Mercy because “as they shook his hand, they’d be fixing his hangnail.” A year and a half after Mercy came to Joplin, the tornado hit.
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Despite his impulse to rebuild in Joplin, CEO Britton concedes he wasn’t sure how Mercy would afford it. Nobody understood the full extent of the damage in those early hours, much less what kind of insurance was available to restore buildings and services. “I had lots of people throwing all kinds of numbers at me about what that decision was going to cost,” Britton says. McCurry, for one, says he assumed the Joplin hospital had minimal insurance, which tended to be the Mercy way — a ministry that typically tries to cover its own losses. He also assumed the hospital had no “business continuation” insurance that would help pay salaries of employees while Mercy rebuilt. But the executives plowed ahead, firming up within the first 48 hours their commitment to rebuild — and to keep all 2,200 Joplin employees on the payroll. “We knew we were going to do it, so why wait to reveal it?” Britton says, adding that he hoped Mercy’s early announcement might help spur others to step forward with pledges to help Joplin rebuild. Deciding to stay in Joplin meant Mercy also had to preserve its staff, so keeping them on the payroll made business sense. It also felt true to Mercy’s mission. “There wasn’t much brilliance to what we were doing,” McCurry says. “It just felt right.” Looking back, he says, it now feels like the most brilliant thing they’ve ever done. It helps that, later that week, Mercy learned it in fact had pretty good insurance on the Joplin hospital, including some coverage for worker wages. Altogether, Mercy might recover about $700 million in insurance payments. That still leaves a hole of $200 million to $300 million, which McCurry says hurts but isn’t crippling. Joplin will leap from a building that was outdated as a medical center to one that is custom-designed for modern health care, says Gary Pulsipher, the hospital’s president. And the city will have a striking landmark that should help ease the memory of a ruined St. John’s. The new Mercy Hospital Joplin will occupy a beautiful building on a hill overlooking the region’s busiest highway. “I love

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the fact it’s on the interstate,” Pulsipher says. “People won’t have to wonder how they get to the hospital.” He and others agree that another company might have taken the insurance money and invested it in a major metropolitan area, leaving behind the less-lucrative market of Joplin. Mercy won’t get back that $700 million in profits from Joplin, at least not in the lifetimes of its current executives. Then again, says McCurry, “we weren’t thinking like businessmen.”

Pulsipher speaks outside the ruined hospital less than three days after the tornado.

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A CLOSER LOOK

The recovery takes root
No one at Mercy had experienced a disaster like the one that struck St. John’s hospital in Joplin. But everyone thought of the experiences of others in recovering from tragedy. Mercy CEO Lynn Britton remembered Oklahoma City and how citizens created a memorial that was positive and looked ahead. Others remembered Hurricane Katrina or other tornados where residents pulled together to rebuild and restore their communities. A different kind of story came to mind for Terry Bader, who helps oversee Mercy design and construction. It was 70 miles south of Joplin where something positive was underway — the construction of a new hospital in Rogers, Ark., that opened in 2008. Mercy was clearing the site near an interstate highway to replace Mercy’s aging hospital in town. In the way stood a stately persimmon tree. “We knew we had to take it down,” Bader says. But instead of turning the tree into mulch, “we had a local guy make pen and pencil sets out of the persimmon wood. We gave those sets to all the leaders in the community so they could have a part of the site’s history.” Now Mercy has cleared more than 100 acres on the south side of Joplin for a new hospital. A small woods covered part of the site, including oak, sassafras, dogwood, redbud and hickory trees. Taking them down was painful after the tornado took out thousands of trees across Joplin just months earlier. Planners kicked around what they could do to ease the pain, looking for something that would also fit “our lean-and-green approach to things,” Bader says. Along came Joplin resident

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Workers identified saplings that were 32 most likely to survive transplanting.

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Marcia Long, who suggested at a Mercy community roundtable that saplings from the site be saved and replanted when construction is done in 2015. Jumping on the idea, Mercy and its landscape architects at SWT Design quickly hired a nursery to save about 470 saplings from the construction site and move them to a nearby tree farm. The farm will nurture the trees for the next three years. “When we get them back, they will be nice and healthy,” Bader says. They’ll join another 1,000 trees along with grasses and wildflowers that will make the property more abundant than before construction. Much of the lumber from the felled trees will help rebuild Joplin, going to other construction projects around the recovering city. Craftsmen will carve some into Mercy crosses. Saving the saplings is just one way that Mercy is trying to preserve and restore what its co-workers and the wider Joplin community hold sacred. Some artifacts will remain as part of a memorial garden at the site of the old St. John’s. A few will become part of the new Mercy Hospital Joplin now under construction. Designers don’t intend

Missouri conservation officials applauded Mercy, saying they knew of no other company that has worked as hard to reuse trees on a construction site.
Photos courtesy: SWT Design

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to install them as obvious memorials in the new building, but incorporate them as subtle and tasteful reminders of the spiritual continuum that bridges the two Mercy hospitals. The stations of the cross, for example, survived in the former hospital’s chapel and can become part of the new. Also intact — and somewhat miraculously — were the stained glass windows from the chapel. They, too, will help bring a familiar and comforting touch to the new chapel. The new hospital is near the Wildcat Glades and Audubon Conservation Center. Mercy worked with the Audubon Society and government agencies to ensure that construction would not harm the center’s ecosystem. Now Mercy is working to make its campus blend comfortably with the glades. Mercy planners envision a day when Joplin students will conduct science experiments at Wildcat Glades and the Mercy campus. Perhaps, they will take measure of the saplings that survived the deadliest tornado in U.S. history and returned to provide shade and comfort to a community on the mend.

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New hospital leads the way

F

ootsteps haunt hospital designers. Not the sound of footsteps, but their tracks. “We don’t like those footprint stickers they put on the floor for people to follow,” says Mercy’s Cindy Beckham, who helps oversee facility design. Old hospitals, like the tornado-wrecked St. John’s in Joplin, needed the stickers to guide patients through a maze of hallways, offices and check-in points. Routes get twisted over the decades as aging, inflexible

The new hospital entrances include shelters for patients and employees waiting for rides.

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buildings struggle with new services, specialties and other health care changes. So it’s with pride that Beckham and others show off the simple and flexible floor plans for Mercy’s newest hospital, part of a $500 million health care campus under construction on the south side of Joplin. The new campus replaces the old St. John’s after it was left in ruins by the 2011 tornado. Not wanting to wait for demolition to finish at the old campus, Mercy leaders broke ground for the new Mercy Hospital Joplin in January 2012. Crews cleared more than 100 acres of land to open a blank canvas for painting the next generation of Mercy care. When it opens in 2015, the eight-story hospital will be the centerpiece of a $1 billion string of investments Mercy is making in the Joplin area. The outlays include other temporary and permanent medical facilities, the cost to keep paying Mercy employees in the interim, and money to lease and expand Mercy McCune-Brooks Hospital in Carthage, just north of Joplin. The addition of Mercy McCune-Brooks and the new hospital to the south promise a dispersed Mercy system that will include physician offices across the area. “It’s not just a new hospital,” says Mercy CEO Lynn Britton. “It’s an entirely new, modern health care infrastructure that will enable the Joplin area to meet the challenges of the next 50 years.”

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Starting a hospital from scratch enabled Mercy and its architects to ponder what would make a model facility. They enlisted patients, co-workers and community members as an advisory group for brainstorming sessions on what they wanted from a new building. Many Mercy employees had not worked in a hospital other than St. John’s. Still reeling from the disaster, some tended at first to want to replace what they’d lost. They asked, for example, for registration areas with the sliding-glass windows that patients associate with doctors.

The future hospital
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The new hospital is rising in a relatively undeveloped section of Joplin.

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Conversations, however, soon turned to reducing those types of traditional walls between patients and caregivers. And instead of multiple registration desks for different departments, as in the old St. John’s, conversation turned to the breakthrough idea of a single place where patients could register for any and all departments. Gaining momentum, the innovation reached across other areas including medical records and financial counseling. They, too, could rely on mobile technology to bring paperwork to patients rather than asking them to find their way to other doors. Essentially, the hospital and clinic won’t have conventional registration desks. An employee greets patients as they arrive, and any questions or papers are brought to them. “With the modern technology we have, we’re able to get rid of a lot of the old barriers to care,” Britton says. “The old things that made you feel less dignified in health care, we’re rethinking all of that.”

Patients have responded warmly to prototypes for Mercy’s new interior design, saying they don’t feel like medical offices.

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Even the hallway lobby where patients arrive will look remarkably different from a traditional hospital. Designers talk of the area as more of a “gallery” instead of a waiting room, a warm place with sofas and tables. No more hard-floor fishbowl with straight-back chairs along the wall. Even the art might be interactive to help distract patients and families from the concern behind their visit. The convenience doesn’t stop in the hallway. Increasingly mobile medical technology means a patient can go to a room for an exam and stay there for a wide range of tests. A technician could come to draw blood, or bring a portable ultrasound machine or heart monitor. A specialist doctor could also come to the room for consultations. The idea is that the people who work there know their way around the hospital; the patient won’t need to.

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These innovations aren’t unique to Joplin. “We’re doing different pieces of this across Mercy communities,” Britton says. “Joplin is the first place where it is all coming together.” The new hospital will open with about 600,000 square feet of space and more than 200 patient beds. Combined with other facilities and an expansion of the former McCune-Brooks, Mercy plans to have more than 400 beds in the Joplin area. Other facilities on the new campus will include a behavioral health clinic and perhaps a rehabilitation center, bringing Mercy’s new space in Joplin to nearly 1 million square feet, similar to what it lost to the tornado. Plans for the new hospital itself include medical and surgical care, critical care, intensive care, cancer care — as well as greatly expanded care for women and children, with labor, delivery, recovery and postpartum rooms and neonatal and pediatric intensive care. In addition to clinical space and beds, the building will house some doctors’ offices, which typically are found in other buildings near a hospital. Specialty physicians and a few primary doctors will have their offices in the hospital. They’ll have a short walk to see patients for an exam or visit them in their rooms, have lab tests and imaging conducted, or even undertake major surgeries. Cardiologists will have offices on the same floor where heart patients rest, obstetricians and pediatricians on the same floor as mothers giving birth. Crews will finish the hospital in less than 40 months, and groundbreaking came after only a few months of planning. The speed is enabled partially because of a design that, while unique to the site, is full of standard “modules” drawn from a guide that governs new construction across the Mercy system. “That means we could start building before it was fully designed,” says John Farnen, a Mercy leader who is supervising construction in Joplin. A clinic module, for example, can be a freestanding facility, or several can come together in a larger clinic. Designers used a passel of modules for specialty clinics, emergency departments, doctors’ offices and others in planning the Joplin hospital.
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Groundbreaking after months of planning: Bishop James Vann REBUILDING Johnston of the Springfield-Cape Girardeau Diocese, right, and Father Safari Burusu bless the new site on Jan. 29, 2012.

Designers didn’t even have to know which clinic modules might be used for what specialties as construction got underway. The standards allow flexibility — as demands and specialties shift, whole sections can be converted. Even individual rooms can shift with the seasons, such as those adjacent to pediatric intensive care. Rooms across a hall can be added to the pediatric ICU when winter comes and more kids get sick, and later shifted into something else. “It’s really about the need at the time,” explains Beckham, who joined Mercy several years earlier to help fashion the ministry-wide designs. The hospital, in fact, adds a neonatal intensive care unit that wasn’t in St. John’s. Too often, families had to travel to another city when their newborns were sick. The neonatal care complements an expanded labor and delivery department in the new hospital as Mercy aims to better serve Joplin’s youngest infants and their parents.
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The new campus
Other buildings on the hospital campus will include a rehabilitation center and perhaps a behavioral health clinic, among others.

Hospital entrance

Hospital building

Clinic entrance

Parking spaces radiate outward

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Ministry-wide design guidelines include the building’s exterior, which shares a look with other Mercy clinics, hospitals and offices. The familiar appearance is part of a major effort across the organization to merge Mercy’s hundreds of sites into a familiar brand. It’s partly about marketing, but more about patient service. The same electronic records are available across Mercy and make it easier to treat a patient at any of its facilities; standardizing buildings and processes will help patients understand that’s possible. Their experience also will feel familiar wherever they go within Mercy. The modern design includes subtle references to Mercy’s traditions. Entrances, for example, include a prominent glass wall whose interior lighting serves as a sort of lamp guiding those in need. The window’s mullions form a cross that is similar to one Catherine McAuley, the founder of the Sisters of Mercy, had prayed to in the window of a Quaker household, where she was not allowed to display Catholic icons such as crucifixes. Employees who know the story can see the cross, as well as patients who take comfort in the religious symbolism. Convenience for patients at the new hospital reaches into the surrounding parking lots. Most hospitals have one main entrance, but the new Mercy Hospital Joplin will have two, one for the hospital and one for the clinic. The two entrances help divide traffic and bring patients into the building on different floors. They also put parking on both sides of the hospital, meaning smaller lots and shorter walks. And unlike the grid-like lots at a shopping mall, the hospital’s will stretch across an arc. That will allow the lines at each parking spot to widen outward, opening more room for those exiting with canes or wheelchairs. Whichever door they choose, patients will enter into wide hallways with an obvious path to elevators or the receiving gallery, where they’ll be greeted and checked in. Designers planned other floors with similar simplicity in bringing patients to any office or service. No more floor stickers to find their way, Beckham says with a laugh: “No footprints, no way.”
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A CLOSER LOOK

Mercy mission: Beyond a hospital
“We have a nose for need,” says Sister Mary Roch Rocklage, Mercy’s health ministry liaison. When it comes to health care, that need often is found in rural areas. Only a sprinkling of Mercy’s more than 30 hospitals are in major metropolitan areas. The rest are in small-to-mid-size communities like Joplin. “It’s who we are,” says Mercy COO Mike McCurry. “The community means a lot more to us than the market.” In Joplin, the Sisters of Mercy began providing health care to those most in need soon after they arrived, originally to teach. They saw a glaring need for a health ministry in the frontier mining town, and opened the town’s first hospital in 1896. Today, Mercy helps fulfill that mission by extending some of the most sophisticated medicine in America to rural settings across its seven-state ministry. “It thrills us to be able to do that,” says McCurry. Small communities, for example, often wrestle with a shortage of specialists. Mercy’s system, combined with the latest technology, has helped developed cutting-edge solutions. Take neurology, the treatment of disorders in the brain and nervous system such as those caused by strokes. Rural markets often can’t support expensive specialists such as neurologists. Mercy has responded with its “telestroke” program, which electronically links patients around the clock to far-flung neurologists. Powerful cameras in a rural hospital enable a distant doctor to diagnose strokes — and prescribe medicine that limits the damage if caught early. Mercy is deploying the technology across its hospitals.

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Mercy’s seven-state ministry
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A similar system called SafeWatch enables doctors to electronically monitor intensive care units at a distance, and provides patient access to highly specialized physicians. Mercy has the nation’s largest electronic ICU network. Mercy offers other advantages to communities like Joplin. The system’s purchasing power and management expertise offer the benefits of size to small hospitals. Also, a more serious gap opens in a smaller community than in a big city if a specialist leaves. “You have to fill the void in a hurry,” says Ron Ashworth, chair of Mercy’s health ministry. “We offer a large recruiting reach.” McCurry notes that he and Mercy CEO Lynn Britton grew up in small towns. They take special satisfaction in Mercy’s focus on communities like their hometowns. And while he doesn’t answer to the conventional shareholders of a public corporation, McCurry likes to say that Mercy has three million shareholders — its customers in towns like Joplin: “They are people with real needs who we exist to serve.” Or, as Sr. Roch puts it, “We’re at home in any community.” Nothing challenged Mercy’s mission more than the 2011 tornado, which threatened not only the future of its Joplin hospital but the future of Joplin itself. Mercy’s decision to stay and rebuild means the area not only keeps the high-quality care for which Mercy is known, but it also encourages other residents and businesses to do the same. “We want to be a permeating presence,” Sr. Roch says. “How do we become a part of those communities and help change them?” In Joplin, Mercy is living the answer to that question.

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About this series
As the nation remembers the storm that ravaged Joplin in May 2011, Mercy has published a series of books on the events that changed the lives of so many in the community, and how the health ministry has responded. The books include this one, “Rebuilding,” which explains how Mercy has replaced the hospital destroyed in the tornado. In “Caring,” Mercy affirms its commitment to its workers and the community of Joplin. In “Enduring,” Mercy captures stories of courage in the aftermath of the tornado and looks ahead to Joplin's future. The works weave a story of past, present and future — and Mercy’s promise to value all three.

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