History: 1980s - Planning for the Future

As time advances and the 1980's are recorded as part of our historical past, this era may be remembered as a time of prosperity for some, while the poverty of others underscored the existing social inequalities. Racial tensions lead to demonstrations and riots. Internationally, communism failed as countries previously- under subjugation broke free to establish independent nations. AIDS, a disease that cut across national, cultural and social boundaries, became the most feared enemy of the times.

Health care changed dramatically in the 1980's. Leading policy makers sought solutions that would slow the constant escalation of costs. What resulted was an era of turbulence for hospitals. Diagnosis Related Groups (DRG's), competition, marketing, corporate restructuring, diversification, strategic planning, health maintenance organizations, alternate care options, cost containment, cutbacks and technologic advances were all issues that had to be confronted by those responsible for managing hospitals.

In 1983, the Federal government, in an effort to control Medicare costs, adopted DRG's, a new form of reimbursement. Payment for hospitalization was now based solely upon a principal medical or surgical diagnosis and often did not accurately account for the treatment rendered to patients who had multiple medical problems. External peer review organizations maintained a watchful eye over hospitalizations and made decisions regarding their appropriateness based upon "severity of illness and intensity of service." For the first time, physicians, administrators and, more importantly, patients faced "denial of payment" issues, creating anger and disillusionment.

Unfortunately for Windham Hospital the problem was further compounded by its "rural rate" designation which meant Windham would receive less reimbursement per patient discharge than other hospitals in the state. This reduction in revenue came at a time when costs, especially those associated with salaries and new equipment, were rising. During this era, considerable time and energy were expended on reviewing budgets, making necessary cutbacks and appealing regulations.

In an attempt to accommodate itself to the changing times, Windham began developing and expanding outpatient services. Beginning in the early 1980's, members of the Patient Education Committee worked with John Peck, Administrator, and staff in the development of community health education programs. Diabetes Education, consisting of in-patient teaching, out-patient group classes and individual instruction was implemented. In liaison with the American Diabetes Association, Connecticut Affiliate, the hospital successfully established a chapter in the Willimantic area. Other programs concentrating on asthma, mastectomy and heart attacks were initiated and were intended to promote wellness and inform patients and families about self care.

An in-hospital closed television network was set up for patient instruction. Marie Hakmiller, Director of Volunteers, implemented Tel-Med, a telephone information service that provided answers to common health questions. The Social Service Department, in cooperation with Emergency Services, initiated Lifeline, an emergency response system intended to assist the frail elderly who wished to remain in their homes. The Laboratory extended services to physicians' offices, area nursing homes, participated in public health screening programs and began a home visitation program.

In 1985, Windham signed a contract bringing LifeStar helicopter transport services to the area. Patients with head injuries and other unstable conditions were now transported directly to a major medical center for care.

In its Community Services calendar, 43 programs were listed, demonstrating Windham Hospital's commitment to providing community outreach and options to inpatient care. Among those mentioned were alcohol and chemical addiction counseling, a cancer support group, nutritional counseling, a Better Breathing Club, and the Turnaround Stroke program.

Throughout the early 1980's, additional programs were established to meet the total needs of the patient. Hospice, a concept meant to humanize the dying process was introduced. Mercedes Primer, and then Debbie Zlatin, were staff employees most responsible for coordinating hospital and community services within the Hospice. The goal of the program was to assure that terminally ill patients remained in their homes with their families for as long as possible. With this as the intent, the program was transferred to the local visiting nurse association in the latter part of the decade. In November 1987, the Hospice Program produced a film that received an "Award of Excellence" conferring national recognition for outstanding achievement.

A pastoral care program grew with assistance and leadership from the Windham Area Interfaith Ministry. Local clergy continue to minister to the needs of the sick and injured, giving their time unselfishly.

One Day Surgery, Same Day Surgery and Observation Status programs were established to provide alternative ways of evaluating and treating patients. These programs marked the beginning of a dramatic shift from in-patient to out-patient utilization resulting in decreased occupancy rates. Those patients who were admitted to the hospital were sicker and generally had multiple medical problems. The nursing staff were the first to experience the impact of the change in patient mix. More time was necessary to care for more complex cases. Ancillary services required newer, advanced equipment to confirm diagnosis and assure appropriate treatment.

Following the lead of other acute care hospitals, Windham underwent corporate reorganization in 1985. With the ability to create for-profit subsidiaries, the hospital hoped to offset losses that were occurring on the in-patient side. Later it was returned to its original corporate structure, realizing that the hospital needed to remain focused on its primary mission, providing up-to-date medical care to the community.

Despite the demands of the times, Windham continued to provide quality care to its patients and was recognized in this endeavor. The Joint Commission on Accreditation of Healthcare Organizations deemed the hospital fully accredited, without contingency, in 1984. At that time the surveyors said, "This is the first hospital we surveyed this year that has in place all the quality assurance mechanisms that we are recommending." This comment stands as tribute to Raymond Bopp, M.D., Windham Hospital's first Quality Assurance Board Chairman, as well as the medical and nursing staff leaders and department managers who have always made quality their primary concern.

Another challenge at Windham was the continuing recruitment of new physicians to the community. In the mid-70's, surveys showed that the Windham area had a much lower ratio of physicians per 1,000 people than the state or nation. By the mid-80's, Dr. Sawicki, Chief of the Medical Staff reported:

The most influential change at the community hospital level has been the addition of 14 new physicians to the medical staff of Windham Hospital. These physicians expand and enhance the services that the hospital is able to offer. Additional primary care physicians provide services to outlying areas, and new consultants add new sophistication and depth to subspecialty ranks.

The presence of the new sub specialists coincides with new technological sophistication. Additional cardiology testing and monitoring, previously only available at referral centers, are now available at Windham Hospital.

A new endoscopy suite to facilitate the work of complicated intestinal and respiratory problems on an outpatient basis has been established. The laser program is being rapidly expanded to accommodate the increasing use and benefits of our new technology in almost all the surgical subspecialties or fields.

Nursing, under the leadership of Ann Martin, R.N., Director of Nursing Services, developed more fully as an independent profession. A clinical career ladder was implemented that would allow nurses who wished to remain at the bedside gain more recognition and greater financial reward for their efforts. Nurses were once again in short supply. To attract and retain nurses, the Child Care Center was opened and tuition grants and college courses on hospital premises were provided.

Demands made upon the nursing staff in this new era of cost constraints was apparent to everyone. Ms. Martin remarked, "Under the pressure of cost containment, duties will not get any easier, and as of right now I really believe that hospital nursing, if it is carried out correctly, is the most difficult profession in the world."

When Ann Martin, R.N. left in 1987, the role of Vice President of Nursing Services was assumed by Rosemary Hathaway, R.N., Ph.D. Ms. Hathaway expanded educational access for nurses employed at Windham, introduced new nursing concepts, and continued to enhance the image of nursing as an independent profession.

In the early1980's, Windham began revision of its long range plan. Realizing that equipment and the physical plant were rapidly becoming outdated, initial work was begun on a Certificate of Need.

In 1987, Fred Hyde, M.D. was appointed President of Windham Hospital. With an extensive background in hospital planning, Dr. Hyde worked with the Board and medical staff leadership to formulate plans that would revitalize the hospital.

Turning first to support services, specialists were able to practice in an environment of advanced technology as new equipment was purchased for cardiology, radiology, nuclear medicine and the laboratory. A fixed-site CT Scanner replaced a mobile unit shared with other hospitals. Later, a certificate of need for an MRI, an even more advanced diagnostic tool, was approved by the Commission on Hospitals and Health Care. Mammography services moved beyond the boundaries of the hospital to off-site facilities located in Mansfield Center and Stores.

The purchase of newer equipment and employment of additional staff in Physical Therapy and Occupational Therapy equipped the growing rehabilitative services, managed by Peg Bernier, to locate out-patient community-based centers in Willimantic and Storrs.

Recruitment of new physicians and implementation of a physician referral line improved community access to medical care. In response to changing surgical techniques, new instrumentation was purchased, making laser and laparoscopic surgery routine at Windham.

Educational programs that train the next generation of health care providers were expanded to include Associate of Science in Medical Laboratory Technology (affiliated with Manchester Community College), Bachelor of Science in Nursing (affiliated with the University of Connecticut School of Nursing), Educational Programs for Physical Therapists, Educational Programs for Occupational Therapists and Certified Occupational Therapy Assistants, Hospital Pharmacy Extern Program (affiliated with the University of Connecticut School of Pharmacy), Medical Laboratory Technician Program, Medical Transcription Program, Practical Nurse Program (affiliated with the Windham Regional Technical School), Radiologic Technology Program (conducted at Windham in cooperation with Backus, Day Kimball and Rockville Hospitals), Ultrasonography Program, Respiratory Therapy Program and Multi-skilled Health Technician Program.

Liaisons with the University of Connecticut Health Center were established, bringing residents and medical students to Windham's obstetrical service. Windham's Prenatal Clinic remains instrumental in addressing high infant mortality rates associated with otherwise inadequate prenatal care. Under hospital management, the Windham High School Health Center provides comprehensive student health services.

Further community outreach now includes an AIDS counseling program sponsored cooperatively with the State and local community organizations; support for a medical transportation van in conjunction with the Windham Regional Community Council; continued involvement with the Hospice Program managed by the Eastern Connecticut Visiting Nurses and Home Care, Inc.; and the provision of space and associated resources for low income clinics, rape crisis and service organizations.

In 1990, Windham Hospital received a three year accreditation from the Joint Commission on Accreditation of Healthcare Organizations. Its score was close to the maximum and resulted in a special letter of commendation from the President of that national accrediting agency.

Of greatest consequence to the community was the successful completion of a major building program that adds 69,282 square feet to the existing facility and incorporates new space for The Alma Hatch Women's Health Center, operating suite, one day surgery, a medical/surgical floor, and a 12 bed critical care unit. Total cost of new construction and renovation is $20 million. Now located on 35.2 acres of land, plans are underway to create a medical complex containing, in addition to the hospital, medical office condominiums and space for other health services.

Each decade of Wmdham Hospital's history has brought continued growth and progress. As the Hospital enters the 1990's it proudly anticipates the celebration of its sixtieth anniversary of service to the communities it serves.