WAKEFIELD – The continuum of health care in Rhode Island is fraying around the edges and unraveling, it seems, forcing a dramatic shift in the definition of what “community” health care means.

Much of the news media’s attention around health care delivery has been focused on the bankruptcy of Steward Health Care in Massachusetts. Six of the bankrupt Steward hospitals in Massachusetts are to be sold, pending approval of a federal bankruptcy court in Houston. The Commonwealth of Massachusetts has pledged some $750 million to facilitate keeping those six hospitals open.

 Two other former bankrupt Steward acute care community hospitals in Massachusetts, one in Ayer, the other in Dorchester, were forced to close on Aug. 31.

And, two of the six bankrupt hospital properties being sold, one in Taunton and another in Fall River, were purchased by Lifespan health care delivery system in Rhode Island for $175 million, in a move described by a Lifespan strategy official as an opportunity to “grab scale.”

In turn, Roger Williams Medical Center and Our Lady of Fatima, two hospitals in Rhode Island owned by Prospect Health, a for-profit private equity firm in California, are teetering over a financial cliff.

Other signs of distress are everywhere in the health care delivery system in Rhode Island. Thundermist Health Center, with facilities serving Woonsocket, West Warwick and South County, is now faced with what its board called a “financial crisis”; the board recently terminated its contract with the health center’s long-time president and CEO, Jean LaChance, after 10 years.

Earlier this summer, Providence Community Health Centers was forced to lay off more than 40 workers, mostly community health care workers,  and close a clinic in Olneyville, one of the poorest neighborhoods in Providence.

Blackstone Valley Community Health Care Center, with facilities in Pawtucket and Central Falls has been struggling for the past two years, following the departure of its long-time executive director, Ray Lavoie.

The grateful dead?    
Meanwhile, at South County Health, the state’s last remaining independent acute care community hospital, the simmering conflict between caregivers and administrators boiled over in public, with the executive leadership at South County Health locked in battle with the hospital’s caregivers to win the hearts and minds of the community served by the hospital’s delivery system.

The dispute has spilled over into the headlines, as a group of doctors, nurses and community members sent an open letter to the board of directors at South County Hospital, calling for a change in leadership, as reported by WPRI’s Eli Sherman.

In what served as a precursor to the open letter, many of the hospital’s oncology doctors [who treat cancer patients] had announced that they were resigning. In the letter, the disgruntled hospital staff called out what they described as an “adversarial relationship” with the hospital’s CEO, Aaron Robinson.

In the letter, the disgruntled hospital staff called out Robinson for having an “abrupt, callous, and confrontational attitude,” accusing the CEO of fostering “division rather than collaboration,” according to Sherman’s reporting.

In response, Robinson blamed the conflict as the result of state health care policy and the reality that South County Hospital was “under funded” – saying the hospital’s  $6 million operating loss from last year had been caused largely by the difficulty of competing with higher health insurance rates in Massachusetts and Connecticut, according to Sherman’s story.

“Just like the Washington Bridge had signs of a failing infrastructure, there’s a failing infrastructure in health care in this state and we’ve kicked the can down the road year after year,” Robinson told WPRI’s Sherman, using an analogy that caught the eye of two of Rhode Island’s top political reporters, WPRI’s Ted Nesi and The Public Ratio’s Ian Donnis.

Digging deeper    
For the last three years, ConvergenceRI has been traveling once a week to South County Hospital to receive physical therapy services for his chronic condition. The Ortho RI facility occupies a second-floor wing of South County Hospital, representing what appeared to be the kind of innovative partnership that the non-hospital centric orthopedic enterprise has sought to develop.

As a result, ConvergenceRI has had a front-row seat as South County Health has grappled with its signage and messaging to patients around its relationship with Ortho RI.

The latest iteration – signage attached to one of the elevator doors leading to the second-floor offices of Ortho RI – was perplexing.

“Are You A Grateful Patient?” the advertising image asked, showing a blonde, middle-aged white man in a hospital bed, talking with a middle-aged doctor in a white coat and stethoscope, his hand extended. “Show your appreciation for the care you have received at South County Health,” the advertising urged.

The second elevator door offered up an advertising image of a smiling blonde, middle-aged woman in a white coat and stethoscope, with the messaging superimposed atop the photograph that said: “Expressions of Gratitude, South County Health.”

Who is truly the target audience?    
The three basic questions that any communications campaign seeks to answer are these: “What’s the message?” “Who are the target audiences?” and “How will you know if the targeted audience has received the message?”

In ConvergenceRI's opinion, the basic problem with the current messaging is that there is no signage on or nearby the elevator doors indicating that the Ortho RI facilities are located on the second floor, the destination for most patients using the elevators.

Secondly, there is no explanation of the difference between South County Hospital and the overall health system, South County Health.

The demographics of who is using the elevators – and not the stairs – seems to be at odds with the messaging, when it comes to identifying whom the target audience is. In ConvergenceRI’s experience, based on weekly observations over three years, a majority of the patients employing the elevators are women recuperating from orthopedic procedures, with walkers, canes and crutches, representing a diverse clientele.

The messaging seems counter-productive to the needs of the patient: How to find the Ortho RI offices? Further, the message seems contradictory: How is a patient of Ortho RI supposed to show his or her gratitude to South County Health? What is their relationship?

Further, the emphasis seems to be misplaced: Are patients supposed to express gratitude to South County Health, or should South County Health be expressing gratitude to the patients for choosing them to deliver their health care services?