Media Recap: Age-friendly Hospital Systems and Nursing Shortages

Sarah Scranton

Sarah ScrantonThe MHA received media coverage the week of April 24 regarding the MHA Keystone Center’s work implementing the Age-friendly Health Systems initiative throughout Michigan and how Michigan health systems are utilizing foreign nurses to fill staffing shortages.

Second Wave Michigan published an article April 27 as part of their State of Health series about efforts being made throughout the state to make Michigan more age-friendly. Sarah Scranton, executive director of the MHA Keystone Center, discussed the importance of prioritizing the needs of Michigan’s aging population and how hospitals are adopting a framework to become more age-friendly.

“Older adults have very complex needs. It’s important that the medical field prioritizes what is important to the patient, not just what they think might be wrong,” said Scranton. “It’s really all about listening to the patient and taking what matters to them into consideration.”

The Detroit Free Press published a story April 28 focusing on how Henry Ford Health and other Michigan health systems are utilizing foreign nurses, particularly those from the Philippines, to fill staffing shortages in nursing. The article referenced two data points provided by the MHA, which includes the 27,000 job openings in Michigan hospitals according to a March 2023 MHA member survey and the loss of 1,700 staffed hospital beds in the state since the pandemic began.

Members with any questions regarding media requests should contact John Karasinski at the MHA.

Age-Friendly Spotlight: Sparrow Ionia Hospital

Learn how healthcare systems are innovating to address the unique needs of older adults through the MHA Keystone Center’s Age-Friendly Health Systems Action Community.

Located in Ionia, Michigan, Sparrow Ionia Hospital is a 22-bed critical access hospital whose patients ages 65 and older represent half of all admitted patients. The hospital has remained committed to quality and safety and has worked tirelessly to improve care practices for older adult patients since joining the MHA Keystone Center Age-Friendly Health Systems Action Community in 2019.

The hospital is nationally recognized as an Age-Friendly Health System Committed to Care Excellence by the Institute for Healthcare Improvement (IHI) for working to create an age-friendly environment for patients. Steven Dexter, medical-surgical unit and special care manager, Sparrow Ionia Hospital, shares insight into the hospital’s age-friendly journey below.

What is an Age-Friendly Health System?

Becoming an Age-Friendly Health System entails reliably providing a set of four evidence-based elements of high-quality care, known as the “4Ms,” to all older adults: What Matters, Medication, Mentation and Mobility.


The IHI recognizes clinical care settings that are working toward reliable implementation of the 4Ms. As of May 2021, nearly 2,100 healthcare organizations have earned either level 1 (Participant) or level 2 (Committed to Care Excellence) recognition in the Age-Friendly Health Systems movement.

  • Level 1 (Participant) teams have successfully developed plans to implement the 4Ms.​
  • Level 2 (Committed to Care Excellence) teams have three months of verified data to demonstrate early impact of using the 4Ms.

Steven Dexter, medical-surgical unit and special care manager, Sparrow Ionia Hospital, shares insight into the hospital’s age-friendly journey in the following sections below.

Photographed left to right: Lisa Harris, Interim CNO; Sally Fox, House Supervisor Mary Whitelock, clinical nurse educator; Steven Dexter, medical-surgical and special care unit manager; and Mary Ziegler, house supervisor.

Why did you join the Age-Friendly Health Systems Action Community?

The need for special focus on older patients is obvious. Currently, more than half of all patients at Sparrow Ionia are age 65 and older, and that is expected to soar throughout the nation because of the baby-boom generation. Sparrow Ionia recognized the need to change the traditional model of care delivery to improve the care delivered to the growing population of older patients. With the MHA Keystone Center’s support, we can focus on what matters to older adult patients rather than only what’s the matter with them.

How has joining this national movement improved and impacted the way you care for older adults?

The impact of our work has resulted in awareness to caregivers that can help institute the 4M framework and intentionally individualize care to that type of patient. Hence, patients find value in the care received. Awareness is what makes the biggest impact, so we spread daily awareness by reporting the percentage of age-friendly patients who are on our inpatient unit.

As part of the Age-Friendly 4M framework of “what matters,” the caregivers at Sparrow Ionia Hospital ask our older patients certain questions. An example of a “what matters” question we use is, “What is one thing everyone should know that matters to you while you are here?” One patient told me that he had been in the war and was scared and alone at that time and now, even though he is older and wiser, he sometimes feels that same way. I reassured him that all the caregivers were there for him and thanked him for his ultimate service.

The medical-surgical caregivers brainstormed a way to recognize the heroes who served our county and thank them for their service while they are in the hospital. As a result, small American flags are now put outside the door of those patients’ rooms, so all caregivers can recognize and thank our patients who are veterans.

Another conscious thing we do to promote age-friendly care is we use small, yellow “4M” door signs to reveal an age-friendly patient so that every caregiver can know that a patient has something that matters to them. In addition to the signs, we elevate the “what matters” answer by discussing them in the daily multidisciplinary rounds so that care can be patient-centered. The answer is charted in the EMR “sticky note” summary front page of the chart.

In addition to these impactful stories, we have seen an increase in patient satisfaction. Patients verbalize the feeling of being cared for and how happy they are with the care they receive at Sparrow Ionia Hospital.

What is one thing you would like to share with a healthcare organization interested in becoming an Age-Friendly Health System?

Age-Friendly is a foundation that most of us use every day with the care we provide. The great thing about this 4M framework is that it can be used for any age group, resulting in intentional, individualized care that patients will see, hear and feel.

CEO Report — Our Commitment to Safety and Quality

MHA Rounds Report - Brian Peters, MHA CEO

If you can’t describe what you are doing as a process, you don’t know what you’re doing.” — W. Edwards Deming

MHA Rounds Report - Brian Peters, MHA CEOThe last week has been an eventful and successful one for the MHA. The Michigan Legislature and Gov. Gretchen Whitmer came to an agreement on the state budget for the new fiscal year, which fully preserves all our hospital and healthcare funding priorities — needed more than ever as our hospitals continue to combat COVID-19 and deal with extraordinary staffing challenges. We were officially honored by Modern Healthcare with the Best Places to Work in Healthcare distinction. And finally, we received great news when Blue Cross Blue Shield of Michigan (BCBSM) announced a $5 million commitment through 2024 to support the MHA Keystone Center’s expanded quality and safety improvement programs. I would like to personally thank BCBSM CEO Dan Loepp for his support of this continued partnership, which is the right thing to do for all Michiganders.

Since its inception in 2003, the MHA Keystone Center has provided leadership and facilitation that has directly resulted in improved patient care and quality outcomes — in other words, we have demonstrably saved lives and saved healthcare dollars. No wonder that the MHA Keystone Center has earned both national and international acclaim.

Our first flagship initiative involved central line associated bloodstream infections (CLABSI). Through that work, Michigan hospitals saw a 22% improvement in CLABSI rates. Initial BCBSM funding also supported work that saw a 31% improvement in catheter-associated urinary tract infections (CAUTI) and a 5.9% improvement in venous thromboembolism.

Following our initial successes, the Great Lakes Partners for Patients (GLPP) Hospital Improvement Innovation Network (HIIN) was created, allowing us to collaborate with our colleagues in Illinois and Wisconsin. Our HIIN efforts from Sept. 2016 to March 2020 produced a total cost savings of nearly $293 million, saved 3,350 lives and avoided 25,204 incidents of harm among hospitalized patients.

The MHA is now one of eight organizations participating in the Superior Health Quality Alliance, a Centers for Medicare & Medicaid Services (CMS)-contracted organization that seeks to improve the quality of health and healthcare through innovation, effectiveness and efficiency in designing and implementing CMS Network of Quality Improvement and Innovation Contractors initiatives that are person-centered and integrated across the continuum of care and services. This important work with federal contracts is yet another way we can improve quality in the acute care setting.

High reliability work has been a focal point for the MHA for several years, which was initiated with our members in 2015. This work ensures exceptional quality of care is consistently delivered for every patient, every time. In 2018, the MHA Keystone Center launched a Reliability Culture Implementation Guide in partnership with our fellow state hospital associations from Illinois, Minnesota and Wisconsin. This guide provides resources available for front-line staff, executive leaders and board members to help identify areas of opportunity.

Over the past year, CEOs representing all our community hospitals have signed the MHA Pledge to Address Racism and Health Inequities, demonstrating our members’ unified commitment to address disparities, dismantle institutional racism and achieve health equity. Recent examples of tangible steps taken to accomplish those goals include the publishing of the Eliminating Disparities to Advance Health Equity and Improve Quality guide and offering a virtual series to address four diversity, equity and inclusion concepts: equitable conversations, equitable messaging, partnership building and diversity pipeline development. The Health Equity guide is geared to assist organizations in addressing health disparities to achieve equitable care by providing key strategies, recommendations for action, implementation levels, and resources to support progress.

Thanks to funding from the Michigan Health Endowment Fund, the MHA Keystone Center recently launched its second Age-Friendly Health Systems Action Community free of charge to MHA members. The Action Community builds on existing practices of participating organizations and combines them to reliably implement the evidence-based framework of high-quality care with all older adults in the system. With Michigan’s aging population, this work is exceptionally important and timely.

One way to help instill a safety culture within a healthcare organization is empowering all members of a care team to speak up if they think something may be wrong. Our patient safety organization created the quarterly Speak-up! Award program five years ago to honor healthcare staff who spoke up to prevent harm, which has prevented nearly $12 million in avoidable costs.

We have also done our part to address the tragedy of opioid overdoses, which lead to more deaths in Michigan than automobile accidents. The GLPP HIIN recently created the Midwest Alternatives to Opioids (ALTO) program; participating hospitals collectively have seen an 11.32% decrease in opioid administration and a 13.38% increase in ALTO administration. Because the COVID-19 pandemic has only worsened the opioid epidemic, we are committed to expanding this important work.

The MHA advocacy and policy departments also assisted in the creation of Project Baby Deer, a rapid Whole Genome Sequencing project to improve pediatric intensive care units and outcomes in Michigan. Genetic disorders are a leading cause of morbidity and mortality in infants. Early diagnosis of genetic disease has the potential to change clinical management in many meaningful ways, including initiating lifesaving treatments, avoiding unnecessary tests and procedures, shortening hospital stays and empowering families with real-time diagnoses to help with their understanding and decision-making. In addition to improving outcomes, Project Baby Deer also can prevent avoidable healthcare costs.

As you can see, we have a rich history that we can be incredibly proud of. And without question, BCBSM has been an instrumental partner with us on this journey, providing some $16 million in direct funding support to date. This new BCBSM funding will help to ensure that our critical work in safety and quality continues into the future. Specifically, it will allow the MHA Keystone Center to increase hospital participation in the Michigan Alliance for Innovation on Maternal Health (MI AIM), increasing implementation of pre- and post-partum Obstetric Hemorrhagic Risk Assessment, increasing implementation of Quantitative Blood Loss Assessment, and increasing the percentage of women who receive timely treatment of severe hypertension. It will accelerate our work on the opioid epidemic by maximizing the use of medication-assisted therapy, and it will allow us to expand our efforts to address healthcare workplace injuries — thereby ensuring that hospitals are as safe as possible for our front-line caregivers.

In each example noted above, we have helped to establish a clear process that people can understand, trust and execute.

Lastly, I want to stress that all Michigan hospitals and their team members voluntarily participate in MHA Keystone Center initiatives to advance safety for patients and workers and quality of care. There is no mandate in place to require hospitals to participate in this work, but they each choose to do so because of their missions to care for the sick and vulnerable. The pandemic has shined a bright light on the unselfishness of our healthcare heroes and their participation in these efforts is another terrific example of the lengths they go to improve care for their patients. I want to thank both BCBSM and our member hospitals for believing in this vital work and taking the steps necessary to ensure evidence-based best practices are implemented to the point that they make a difference in patients’ lives. This is mission-driven work that all Michiganders can be proud of

As always, I welcome your thoughts.

Second Wave – Michigan: Michigan pursues “age-friendly everything” to support growing older adult population

Ewa Panetta

Second Wave – Michigan published a story June 24 about the age-friendly everything movement in Michigan, including the Age-Friendly Health Systems initiative.

The story includes a quote from Ewa Panetta, manager, patient safety & quality, MHA Keystone Center. Panetta discusses the 4Ms Framework that hospitals active in the MHA Keystone Center Age-Friendly Health Systems Action Community are implementing in their organizations. She also shares an example of how simple solutions can be used to align communities more with age.

“There are simple solutions that we don’t think about unless we are in a specific situation,” said Panetta. “We are all going to get older and age. Our goal is that we can age in a way that still provides quality of life.”

Read the article