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Final thoughts from a leader

I remember the first time I met Dr. Dan Rahn. He was taller than I expected, distinguished and had a handshake that could crush a cue ball.

I watched him over a two-and-a-half-day period in late 2013 as he and 60 other health care leaders debated and discussed the issue of obesity in Arkansas. Dr. Rahn was passionately cool, if such a thing exists. He addressed each complexity of the issue with pointed thoughtfulness. He was careful not to dominate the conversation, though when he spoke, people listened.

Through his leadership and that of many others – like Dr. Joe Thompson of the Arkansas Center for Health Improvement and Dr. Joe Bates, now retired from the Arkansas Department of Health – a plan to combat obesity was born.

The plan was formally drafted here at the Winthrop Rockefeller Institute throughout 2014, and in 2015 we sought and received the endorsement of Gov. Asa Hutchinson to launch Healthy Active Arkansas, a statewide initiative to increase the number of Arkansans who are at a healthy weight.

Throughout that process and since, my impression of Dr. Rahn hasn’t changed. He’s often the smartest person in the room, but he treats everyone he encounters with respect.

Today is Dr. Rahn’s official last day as chancellor of the University of Arkansas for Medical Sciences. When I met with him a couple of weeks ago, his shelves were already empty, his desk nearly bare. I encountered that same strong handshake, and Dr. Rahn eased from pleasantries and salutations to a succinct assessment of the origin of Healthy Active Arkansas.

“The starting point was specifically focused on obesity,” he began with the kind of energy one would expect from a leader just stepping into his role, not leaving it. “In Arkansas, we have a strategy for the health care sector. That strategy is insurance expansion, promulgation of electronic health information through incentives, and payment redesign. We’re gradually shifting from a volume-based structure to a value-based structure.”

He continued to explain to me the problem that UAMS and other health care systems face when trying to address obesity.

“If one looks at the drivers of ill health in Arkansas, there is an uneven distribution. The majority of the factors that contribute to ill health are not due to access to high-quality health care services. The majority are due to social and behavioral factors. The general concept is about 80 percent of the determinants of health care outcomes are external to the health care delivery system.

“Through our strategy for health care, we can deal with the consequences of obesity, but we can’t deal with the root cause.”

He says his support for Health Active Arkansas was borne of a desire to “move upstream” and work on strategies to prevent obesity from occurring in the first place. That decision starts at birth with a mother’s decision to breastfeed, he says, and continues through the child’s life with their intake of healthy foods and their level of physical activity (which, he notes, are both often affected by access).

I ask him about the state of Healthy Active Arkansas today, where we are and where we’re headed. I’ve learned over the past several years that Dr. Rahn is not a man to talk around a topic. He keenly analyzed our current organization, identifying that the HAA board is weighing a decision of whether to approach the initiative with a top-down management approach or a bottom-up system of encouragement. Faced with a decision between these two approaches, “the answer is likely ‘yes,’” he says and laughs.

He acknowledges the challenges of motivating players from various sectors to commit to the same ideals, especially if it involves instituting new policies or limiting choices, such as reforming the way vending machines are stocked.

I’ve long thought that Dr. Rahn is a prime example of someone who embraces what Jim Collins called the “Stockdale Paradox” in his best-seller Good to Great. The concept, broadly defined, is that the best approach to problems is to always preserve hope of a positive outcome while always honestly confronting the challenges that are in front of you.

In our conversation, swift on the heels of describing some of HAA’s challenges, Dr. Rahn follows with what has been encouraging to him.

“I think we’ve progressed well with no new funding,” he says. “I think it has been an effective, inclusive process. I think we’ve done a good job of raising awareness of the importance of the issue … and that we need to take control of our own health and our own future – at the family level, at the community level, at the employer level.”

Looking to the future of Healthy Active Arkansas, Dr. Rahn cautions against taking an all-or-nothing approach.

“We don’t want to get stuck saying ‘if we can’t do everything, then we can’t do anything.’”

Another challenge will be determining measures of success that will effectively determine whether our efforts are making a difference.

“This is a generational thing,” he says. “Change occurs across generations. So what will be our measures of success that will provide encouragement to stay the course?”

He also points out the importance of the collaborative nature of Healthy Active Arkansas.

“It’s important for each party or participant to not become something that it isn’t, but to bring its strengths to the table and to be working in collaboration and partnership with other individuals and organizations that have complementary strengths.”

I ask him about health literacy. As someone involved in the marketing aspect of Healthy Active Arkansas, health literacy comes up often as a key issue in the battle against not just obesity, but diabetes, hypertension, heart disease and a host of other health-related issues.

Dr. Rahn points out that health literacy is not about whether people understand technical words about health care, it’s whether they understand important concepts, getting to the “why” of health care and moving to a level of understand beyond just the “what.”

As we move toward that future, preparing to take on those challenges, it will be a little harder without Dr. Rahn involved. Healthy Active Arkansas is losing one of its original champions. Two of his colleagues on the Healthy Active Arkansas board gave their thoughts on the outgoing chancellor.

“Dan provided critical leadership in both articulating and committing both his institution and encouraging others across the state to join together to address this environmental threat to our future health, productivity and economic well-being,” Thompson said.

Dr. Nate Smith, state health officer and director of the Arkansas Department of Health, had this to say:

“Under Chancellor Rahn’s leadership, UAMS has been an invaluable ally in the statewide efforts to reduce obesity and chronic disease. Our progress in obesity prevention and reduction wouldn’t have been possible without Dr. Rahn’s support as chancellor of the state’s only academic health center. Arkansas is a healthier state because of UAMS’ commitment to public health, and Dr. Rahn has been at the center of that commitment for the past eight years.”

Many people know Dr. Rahn better than I do. I can’t share personal stories of fun memories or tell you what it was like to work with him day in and day out. But I’ve watched him lead from a close distance. He hasn’t always led by being in front of a group, but he’s always led.

From my vantage point, Dr. Rahn has been the type of leader Arkansas needed at the exact moment he was here. He leaves Healthy Active Arkansas in good hands, but he will be missed.

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A culture of support

Sasha Cerrato is the creative director for the Winthrop Rockefeller Institute. On March 28, she spoke alongside Arkansas First Lady Susan Hutchinson and others at the Arkansas State Capitol in support of Breastfeeding Awareness Day. The following is part of the story she shared that day.

I’m a full-time working mother of two beautiful girls, the youngest of which was born 18 months ago, about 2 ½ years after I started working at the Winthrop Rockefeller Institute.

When my first daughter was born, I was working at a different company and had limited success in breastfeeding because it was difficult to balance my work schedule with my pump schedule.

During my second-born’s pregnancy, I was determined to do a better job at managing that balance and have more success with breastfeeding.

The thing I never expected was that this time my employer was eager to help me make it work, too.

I live in Little Rock, but the Institute is about an hour’s commute on Petit Jean Mountain. On my first day back our executive director pulled me aside and told me to do what I needed to do. She recognized how hard the transition would be and encouraged me to take the time I needed to make it work for both the Institute and my family.

Shortly after, our director of communications and marketing, my boss, switched our weekly marketing meeting to a time that better suited my pump schedule, and continued to refer to that schedule for future meetings and events.

Examples like these over the nine months that I pumped while working at the Rockefeller Institute are numerous and came from every level of our company.

The fact is, there is nothing about pumping that is easy. In addition to nursing in the morning and before bed, I had to pump four times a day for a minimum of 15 minutes at a time to inch out the milk it took to sustain my daughter while I was at work. And frankly, the only reason I was able to keep that baby on breastmilk through her first year was because the company I worked for supported me in doing it. The Winthrop Rockefeller Institute saw the value in a mother providing the best nutrition I could for my child. They saw the value in supporting a young family. And that meant doing much more than simply following the letter of the law. There’s a big difference between providing space and providing support. The Institute showed me that difference, and for that, I will be eternally grateful.

I’ve been blessed to gain a lot of good experience throughout my career, and I’m to a point now that I know I have options should I choose to look for another opportunity. But any time I’ve toyed with the idea of a new career — maybe something closer to home, slightly better pay, etc. — I think about the culture at the Institute, and the support I receive there, and I realize that they’ve made it so I don’t want to leave. They have earned a devoted employee.

And that is far from unique. Study after study shows that family-friendly work cultures increase employee retention, benefit organizational citizenship behavior, and improve work attitudes.

What I hope my story does is present a challenge: What can we be doing to support one another and encourage family-friendly cultures and policies in our respective work spaces? In my mind at least, the question is vital not only to individual families, but to society as a whole.

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Breastfeeding in Arkansas is gaining momentum

The winds of change are blowing in Arkansas when it comes to breastfeeding.

Our state is routinely near the bottom of the country when it comes to the percentage of mothers who breastfeed, but recent efforts promise a brighter future for Arkansas’ nursing moms.

Earlier this week, I was privileged to speak alongside First Lady Susan Hutchinson and state Rep. Mary Bentley (R-Perryville) at the State Capitol to commemorate the state’s Breastfeeding Awareness Day as proclaimed by Gov. Asa Hutchinson. Rep. Bentley organized the event along with Healthy Active Arkansas to draw attention to Arkansas’ laws regarding breastfeeding in public and in the workplace.

In my 20-plus years working as a lactation consultant, I have seen great strides made in understanding, technology and policy regarding breastfeeding. There are many more resources for nursing mothers now than when I first started, and I’m excited to see more and more mothers take advantage of the support that is available.

As the team lead of the Healthy Active Arkansas Breastfeeding priority, I also had the privilege of attending a press conference announcing and celebrating the Baby Friendly designation of Northwest Medical Center-Willow Creek and Northwest Medical Center-Bentonville on Feb. 14. This press conference and celebration, which was also attended by Mrs. Hutchinson, were important because those two birthing hospitals are the first Baby Friendly designated hospitals in Arkansas.

Only 417 U.S. hospitals and birthing centers in 49 states and the District of Columbia hold the Baby Friendly designation. More than 20 percent of annual births (approximately 807,500 births) occur at these Baby Friendly-designated facilities. Every hospital that attains the Baby Friendly designation moves us closer to meeting important public health goals of increasing the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies. In 2007, only 2.9 percent of U.S. births occurred in Baby Friendly-designated facilities. The Healthy People 2020 goal is 8.1%.

After the press conference last month, the leadership team and committee members of Northwest Medical Center-Willow Creek and Northwest Medical Center-Bentonville met with Baby Friendly team members from several of the other hospitals around our state that are currently working toward this prestigious and important designation. The information they shared with us was invaluable. They reviewed common roadblocks and solutions and provided needed encouragement for the challenges that will be faced in obtaining designation. With the leadership of our two designated hospitals, and the support of Healthy Active Arkansas, there will be six additional Baby Friendly hospitals in Arkansas within the next two years! 

The Baby Friendly journey creates an environment that is supportive of best practices in maternity care and of optimal infant feeding. The 4–D Pathway is a fit for all institutions; large and small hospitals, for profit and not-for-profit hospitals, teaching hospitals, and hospitals at various stages of development in their breastfeeding support programs. If you would like more information on how your birthing facility can make a commitment to improve infant feeding policies, training and practices by embarking on the 4-D pathway to Baby Friendly designation, visit the Baby Friendly USA website.

Jessica Donahue is a registered nurse and lactation consultant for Baptist Health in Little Rock, Ark. She serves as the breastfeeding priority area lead for Healthy Active Arkansas, a statewide health initiative that both Baptist Health and the Winthrop Rockefeller Institute helped launch.

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