Kokomo Tribune; Kokomo, Indiana

November 13, 2013

RAY MOSCOWITZ: Close guiding Dukes Memorial to notable recognition

Miami Co. hospital among the nation's top 620, nonprofit says.

MC Weekly

---- — The little girl who adored the purple capes nurses once wore is now the tough-minded woman who’s successfully leading a progressive hospital.

She’s Debra Ann Close, 58, whose steely professional demeanor in a demanding environment is tempered by the sensitivity in her nursing soul.

Now in her seventh year as the CEO of Dukes Memorial Hospital, Close has guided the facility to notable recognition.

In doing so, she has represented just 12-18 percent of women who are CEOs of America’s 5,724 hospitals, according to a new study in the Journal of Health Care Leadership.

On Oct. 30, Dukes was named one of the nation’s Top Performers on Key Quality Measures — for the third straight year. The award, given to 620 hospitals, is made by The Joint Commission, an independent, not-for-profit organization, which, Close says, is the leading accrediting organization of health care facilities in America.

Dukes was recognized for its achievement on the Pneumonia Measure Set, a set of best practice criteria for the treatment of pneumonia. This involves “evidence-based clinical processes that are shown to improve care for certain conditions,” Close noted.

Dukes, which employs 302 people, is a member of the Lutheran Health Network that serves 23 counties in northeastern Indiana and northwestern Ohio.

In 2008, Dukes and Lutheran Hospital in Fort Wayne jointly developed and implemented a Level 1 Heart Program, a chest pain system that enhances the care for acute heart attack patients, Close explained. The Level 1 is activated when a patient is recognized to be having a heart attack.

Activation can occur from the scene of an emergency or in Dukes’ emergency department.

“The goal is to activate, stabilize, transport and have the blocked vessel open in less than 90 minutes,” Close said. “When a patient is identified, Dukes picks up a phone that automatically connects the hospital with Lutheran Hospital, the first accredited chest pain center in Fort Wayne. The call activates established protocols for acute heart attack patients prior to a patient's actual transfer.”

In 2012, Dukes became Chest Pain Certified by The Joint Commission, Close said. Hospitals must pass a “rigorous testing and process improvement to become an elite facility with a staff that understands how to treat patients with chest pain.”

This year, Dukes achieved Joint Commission Stroke Certification, similar to chest pain certification.

While attaining such accreditation, Dukes has initiated a new obstetrics unit, a new ICU, and a new medical and surgical unit under Close’s watch.

New state-of-the-art technology for heart, orthopedic and neurological testing has also come on line. Dukes has specialists in cardiology, neurology and orthopedics trained to use new techniques, Close said.

The advancements have been driven by a driven woman who says her personal philosophy has always been, “God puts us here in hopes we leave things in better condition than when we arrived.”

That belief began to take shape early on for Close, who was born in Hindman, Ky., to Opal Williams-Short, a nursing assistant in physician offices, and Denzil Short, who worked in steel mills and foundries.

The family was living in Gary at the time of Close’s impending birth. But her mother wanted to be with her parents in Hindman for the delivery.

When Close, the oldest of five children, was 5 years old, her parents moved to Auburn, Ind.

“I always wanted to be a nurse and was headstrong by the time I was in first grade,” she said. “I had two aunts who were nurses. I loved the white uniform and purple capes.”

While attending DeKalb High School in Waterloo, Close worked part-time at DeKalb Memorial Hospital in Auburn. The hospital awarded her a full scholarship.

She earned an associate degree in nursing at Purdue University, Fort Wayne, a bachelor’s in nursing at Ball State and a master’s in nursing and health care administration at IPFW.

After getting her bachelor’s degree, Close began her career as a graduate nurse and then became a charge nurse at DeKalb Memorial.

Several important jobs followed. Chronologically, here are just three before coming to Dukes:

• Director of operations, outreach and nursing officer for regional diabetes center, Parkview Hospital, Fort Wayne.

• Chief executive officer, LaGrange Community Hospital, LaGrange, Ind.

• Director of cardiovascular and neurosciences service lines, St. Mary’s of Michigan, Saginaw, Mich.

Close said she moved into management “not because I didn’t like being a nurse, but because I liked overseeing patient care and the outcomes as much as I liked the bedside care [of being a nurse].

“I also felt very strongly early in my career that direction on how to deliver care is best given by those with clinical experience. That is not always the opinion of my peers, or business experts. I know the impact of decisions I make on patient care firsthand. I think it makes me a better administrator.”

Close says her professional philosophy is “to provide the most advanced care technology close to home. No pun intended.”

She continues: “Being sick, having an emergency, needing surgery are not fun experiences. We see people in the worst situation for the most part. Having to travel back and forth to the big city for health care stresses the whole family and support system in so many ways, adjusting work schedules, traveling, the expense of it all. I want to help make that experience a little easier on the individuals.”

Close says hospitals will need to think differently about the delivery of care, especially with physician shortages. “That may mean we will all be using nurse practitioners as requirements change to require doctorate-level preparation for nurse practitioners.”

She thinks independent, stand-alone hospitals won’t exist in five years. “[They] will merge with systems to allow greater buying power for supplies and equipment. It is just too costly to be in health care by yourself.”

Big challenges will continue, including the recruitment of family-practice physicians, especially in rural communities. “There are just not enough physicians wanting to be family doctors.”

Another challenge, she says, is managing the daily unknowns resulting from external forces, such as government regulations and consumer needs.

Which gets to the Affordable Care Act (ACA).

Close is her straight-talking self: “My personal feelings are that regardless of which political party was in power, we needed intervention as a nation. People are without health care, and it’s expensive to have a life-threatening illness.

“Statistics show many Americans filing bankruptcy to pay for health care debt. Without insurance it’s a lose-lose situation for everyone — the patient, the hospital, the doctors and ultimately families.”

She thinks the ACA, based on household income and dependents, may make more people eligible for health insurance coverage through Medicaid or other affordable insurance options on the Health Insurance Marketplace.

Asked if she sees negatives in the ACA, she responded:

“There are a lot of horror stories and inaccurate quotes being circulated. I have two volumes of books explaining and analyzing the Patient Protection and Affordable Care Act implementation, and I understand health care. I question how others not versed in health care can translate the act so easily and on the spot. It has been a challenge for those of us in health care to understand the meaning and impact.”

People in her position “are going to have to figure out how we fund this without burdening low income and the shrinking middle class,” she says.

Asked about changes she has seen in her career, Close says the greatest shift has been in advanced technology. “It’s incredible to see how far health care has grown in treating heart, lung, kidney and bone disease from drug therapy, surgical interventions and even transplants.”

Another major advancement has been minimally invasive surgeries and the expertise surgeons need to use equipment that makes those surgeries possible, she noted.

Changes requires staying attuned to the community. Close is involved with the Peru Rotary Club, the Miami County Health Department, the Miami County Chamber of Commerce, Ivy Tech, the YMCA, Peru Community Schools, North Central Indiana Workforce One, and economic development.

She and her husband, Jack, attend the First Presbyterian Church. He is retired from BF Goodrich after 30 years as a journeyman skilled tradesman.

The Closes have three children and two grandchildren — and a pack of alpacas.

Their oldest child, Jack Jr., is the project and construction manager in Fort Wayne. Shawn Joseph is completing an internship in heating, plumbing and air conditioning. And Patrick Ryan is director of development for the Miami County Community Foundation.

The Closes raise alpacas at their Gentleman Jacks Alpaca Ranch in Peru.

“We are busy with fiber shows and continuing to improve our knowledge base regarding alpaca,” Close said. “Our whole family has become quite involved in helping us on the ranch.”

The alpacas figure to be around for a while. Says Close:

“I am very committed to remaining in Miami County for the remainder of my career. I am very determined to leave a legacy of increased technology and great medical outcomes.

“I really enjoy what I do. It is not just a job; it is who I am.”

Ray Moscowitz of Bloomington is a retired newspaper executive and former publisher of the Peru Tribune. Contact him at r.mosco@comcast.net.