You likely won’t find Kristy Capps, BSN, RN, at her desk or anywhere else within Providence St. Mary Medical Center for that matter. As the Community Nurse Case Manager of Population Health, she spends most of her time in the community caring for their most vulnerable populations.

Kristy meets her patients wherever they are—on the street, at a soup kitchen, or under a bridge. She brings a cup of coffee and a listening ear to learn about their needs. Her approach is
not one of sympathy but of optimism with a lens toward problem-solving. She believes patients often just need a couple of practical things—like a meal and shoes—to start on the road to healing. Some relationships develop quickly, while others may take years to form, and for patients to attain their goals and gain access to quality medical care.

“My patients battle chronic homelessness, substance abuse, mental illness, domestic abuse, multiple ACEs, which are like cement blocks on their backs,” said Kristy. “By showing
compassion at every encounter, we give it value, and ideally that leads to an authentic healing relationship.”

Kristy always had a passion and special ability to create non-judgmental safe spaces. In 2020, Kristy met “S,” a transgender patient with a long history of traumas, who was living in a van with their dog. She was very concerned about how sick “S” was with COVID. Kristy made arrangements with hospital security so “S” could keep their van in the parking lot, just so Kristy could regularly check vitals, and provide medicine, food and water. With the trust that formed, “S” recovered from COVID and with Kristy’s help now has stable housing and is working to open an LGBTQ safehouse in Walla Walla.

“By listening to ‘S,’ I learned about the magical person they are, and all they’ve overcome. That kind of strength is worth preserving,” said Kristy. “Whole person care is so effective when it is consistent and genuine.”

Kristy and her team also spearhead various health equity programs through their Mobile Outreach Clinic and Promotoras (community health workers), reaching the undocumented, and chronically underserved Hispanic population. They have been able to provide medical homes and free care to many in the community. Furthermore, Kristy collaborates with community partners to address social determinants of health, and also obtains wrap-around services for patients with a criminal history. This provides support that works toward their sobriety, addresses their legal issues, and increases success in several aspects of their lives.

Kristy was a co-founder and co-chair of the first Best Practice Council for the Providence St. Mary’s medical group, which was the first Best Practice Council for the medical groups in the entire Providence system. She serves the hospital as a High Reliability coach, and an Ethics Resource Specialist, and is a member of L.E.A.D. (Law Enforcement Arrest Diversion) work and policy groups, as a representative for Providence St. Mary Medical Center. During the pandemic, Kristy was a dedicated COVID nurse, administering vaccines in the community and working closely with epidemiologists and contract tracers from the county department of health.

“The shepherding of people through reassimilation back into housing or medical care remains a remarkable testament to Kristy’s work,” said a colleague. “She has been an inspiration to her colleagues by how she compassionately cares for the community around us.”

“Kristy has such an amazing heart and spirit and brings compassion and joy with a twist of her own unique spunk,” said a patient. “When I was at my lowest, Kristy made me feel I was worth something and helped save my life. She has become more like family to me.”

As the patient rolled in yelling, the trauma team did their best to calm and hold him to do their assessment. This only caused him more distress. Dr. Laura Harmon immediately recognized him as a patient of hers. She calmly took control and kindly asked the team to take a step back, stop talking, and just be present, and let the patient settle. He did, and the team was able to resume their exam and care for him.
 
“Trauma patients by nature are a vulnerable population. They often arrive injured and with their clothes cut off them,” said Dr. Harmon, a trauma surgeon at Boulder Community Health (BCH). “The most sacred part of the practice of medicine is not the actual scientific part, but rather the emotional protection of a person while we meet their medical needs.”
 
In her role as the Trauma Medical Director and Chief of the Department of Surgery, Dr. Harmon has transformed the model of care BCH provides, integrating evidence-based, trauma-informed care into their everyday practice. Injured patients suffer not only physical but also emotional trauma, and attempting to navigate the medical system can become overwhelming and prohibitive. Recognizing that access to care is critically important, especially for marginalized populations, Dr. Harmon helped create a trauma outpatient program that anchors their care. Patients have access to a multidisciplinary team consisting of trauma-informed therapists, physical and speech-language therapists, prosthetists, and subspecialty and primary care providers.
 
In addition to Dr. Harmon’s extraordinary care of patients and their families, she has changed the culture at BCH with her awareness and appreciation for the experiences of her colleagues. After a particularly heartbreaking situation, in which the care team struggled with watching a family experience the loss of their child, Dr. Harmon held a debriefing session. Together with a chaplain, she created a safe space for staff to talk about their experiences.
 
“What has been so striking is that she has reached critical care staff in such a way that they feel safe to process secondary trauma, and are actually beginning to see this as a skill just as necessary as any other to stay resilient and engaged in their work,” said a colleague.
 
Dr. Harmon’s vision extends beyond the walls of BCH. In April 2023, she hosted the first regional Trauma Symposium, which focused on diversity, equity and inclusion with a goal of developing a broader network of community support for patients and their families. One of her patients and his husband joined a panel discussion, which gave staff precious insight into their experiences as trauma survivors and how to best support them. The patient was reunited with everyone who cared for him—from police officers and EMS to the rehab team who helped him learn to walk again. It was as healing for staff as it was for their patient.
 
“There are those very few doctors that by their very nature and presence, transcend the boundaries of skill, competency, knowledge, empathy, kindness and compassion,” said a patient. “I know am being seen and strangely, felt. Simply being in their presence is healing. Dr. Harmon is one of those rare physicians.”

The Complex Discharge Team (CDT) at UK HealthCare was created in 2015 to provide specialized care to patients with complex socioeconomic backgrounds and discharge needs on one dedicated unit. This multidisciplinary team provides holistic, individualized care to a wide array of patients, some of whom are afflicted with medical illnesses that become chronic co-morbidities that cause a decline in functional status.

“To re-engage such a complex patient population, we’ve had to be innovative, creative, empathetic and inspiring,” said Dr. Padmaja Gaddam, CDT Medical Director. The CDT comprises special individuals who persevere despite the odds, compulsively look at the bright side, and root for an optimistic and positive outcome. This team includes a medical director, patient care manager, physician, advanced practice provider, social worker, recreation therapist and nursing staff.

Many patients have mental health conditions or are homeless. They often stay on the unit for many weeks or even beyond a year. The recreation therapist works collaboratively with the team and other non-profit and philanthropic organizations to assemble a variety of activities that bring joy to patients. These include rocking chairs to soothe and calm patients with cognitive impairment, a room equipped with art supplies and a chalkboard wall to inspire creativity, and the use of iPads to enhance patient education.

“These patients, some of whom have not had a single friend or family visit them, have been touched by the empathetic care and diligence shown by providers,” said Dr. Gaddam.

One patient was admitted to their unit after a three-month hospitalization. She arrived with extensive pressure injuries and multiple psycho-social needs and spent more than a year on the unit. During her stay, the team’s expertise and patient-centered approach not only healed her wounds but also assisted in reconnecting her with her estranged, out-of-state relatives. She was ultimately safely discharged to the care of her adoptive family.

In addition to excellent patient safety and health outcomes, including no hospital-acquired infections or falls with injuries for two consecutive years, and a significant reduction in pressure injuries, the unit has strong staff dedication. There has been little turnover despite the workforce challenges facing nursing today. The nurses maintain special skills and receive additional training in palliative care and end-of-life support multiple times a year.

The team’s compassionate care helps build rapport with their patients—even those with challenging behaviors—as was the case with one young man. He was homeless and had multiple ICU stays due to complications of his unmanaged Type 1 diabetes and end-stage renal disease. He was initially uncooperative with care and hostile with staff. But the team’s resolute devotion made a difference, and over time he became more interactive and accepting of staff. He thanked every team member daily for the last two weeks of his life. His passing was dignified with a tearful eulogy, attended by every single team member.

“Compassion is being able to understand what other people are going through and feeling their pain, being mindful of their emotions, thoughts, and experience, and taking action when you see someone is suffering,” said Jamie Cross, Patient Care Manager.

“The Complex Discharge Team exemplifies in spirit and deed the essence of knowledge, care, compassion and empathy that help heal physical ailments and rejuvenate mind, body and soul, said Dr. Gaddam.”

A gruff farmer sits at the bedside holding the hand of his dying wife of 65 years. A young woman faces cancer, angry it’s robbing her of the chance to fully experience life. Stunned parents grieve for their son who sustained a traumatic brain injury while skiing. Each has a story. And Dr. Kathryn Kirkland is there to listen.

“Compassion is probably best defined by its recipient. Different people have different needs,” said Dr. Kirkland, Section Chief and Director of Palliative Medicine at Dartmouth Health (DH). “I try to set aside my own assumptions and perspectives to create space for others to share their stories so that I can understand what’s important to them, how they make sense of the world, and how I can best help.”

Dr. Kirkland’s commitment to the value and practice of narrative medicine shows up in all her roles, from provider to teacher, and to well-respected leader. Her multidisciplinary team often engages in writing exercises to practice taking multiple perspectives. In the process, they increase self-awareness, curiosity, and tolerance for uncertainty.

“I watched with wonder as she met patients, families, and providers where they were—and through exploring the meaning of words and phrases—unpacked treasures she could use to guide others,” said a colleague.

She is a fierce advocate for the use of plain language during serious illness conversations,recognizing the critical role of these discussions in assuring that patients and families avoid missed opportunities—whether it’s spending time differently or making choices to protect themselves from interventions that aren’t aligned with their values or achievable goals.

A visionary leader at Dartmouth Health Dr. Kirkland has also been a force for quality improvement initiatives and systems-level change. She has encouraged her team to be mindful of historical inequities in healthcare and to work to ensure that everyone has access to the best care possible. Many patients in Northern New England are socioeconomically disadvantaged. Some have trouble affording gas for the trip to the palliative care clinic. During the COVID-19 pandemic, Dr. Kirkland and her team accelerated the development of their telehealth program, creating more equitable access to high-quality care in underserved communities.

With her instinct to look toward the larger community they serve, Dr. Kirkland also helped design the first Walk of Remembrance to honor loved ones who have died. It was held in the community at dusk with musical accompaniment, candles, printed verses and care team members present. It was a deeply meaningful demonstration of the importance of taking time to grieve and remember.

“Compassion takes the form of being fully present, and holding space for and bearing witness to, and even absorbing the emotion of others. I often describe this part of our work as being a sponge,” said Dr. Kirkland. “We can take on others’ heaviness; help to carry it for a period. But to be therapeutic over time, to those we serve, we need to recognize that their heaviness is not ours, and to squeeze ourselves out so that we are able to take actions to help, and so that we can be ready to absorb more when needed. And to be sustainably compassionate to others we need to extend this kind of compassion to ourselves.”

Patients and families faced with the uncertainty and challenges of navigating end-of-life often express how fortunate and grateful they are to have Assumptah “Summie” Mwai, CHPNA, walk this road with them. As a senior hospice aide and certified hospice and palliative nursing assistant at Care Dimensions in Massachusetts, Summie is devoted to making a difference and enriching the quality of life of her patients and their families.

“Summie came into our home and lives when we were lost, scared and didn’t know how to care for my mother,” said a patient’s daughter. “She lovingly took care of my mother for almost three years. She came five days a week and ultimately became a member of our family.”

Summie exudes a calm presence and takes the time to listen to those she is working with so she can expertly adjust her approach to best meet their needs physically and emotionally. Along with her team, Summie provides care for patients from various walks of life—all different ages, nationalities, genders, race as well as religious affiliations. Described by her colleagues as respectful, gentle and kind, Summie provides exceptional care to those she works with while honoring their individual wishes and preferences.

“My role is to first and foremost create a trusting relationship with my patients and their families,” said Summie. “I love my job and I do it with a passion. I would never trade it for anything else because I found my true calling.”

As part of her role, Summie serves as a preceptor for newly hired Care Dimensions hospice aides. She agreed to take on this leadership position with the stipulation that she would still take her shifts and serve on the front line, continuing to care for patients and their families. Humble by nature, she doesn’t see herself as a leader, but rather as a mentor, as she wants her colleagues to feel comfortable coming to her for support.

“Assumptah is a selfless and empathetic caregiver and coworker. She will always offer help to those she works with without expecting anything in return,” said a colleague. “Her goal is to help and promote peace and comfort to those she interacts with.”

When one of Summie’s patients lost her memory, and ability to walk and take care of herself, Summie went above and beyond to make sure this patient was well taken care of. Each day Summie would start the morning with music and singing, and then carefully transport her patient from the bed to the wheelchair, and then the shower. Summie helped dress her in beautiful outfits the patient hadn’t worn for many years, accompanied by jewelry and hair accessories.

“Although my wife couldn’t express herself fully in words, her beautiful smile and beaming blue eyes expressed how special she felt all dressed up and ready for the day,” said the patient’s husband. “Summie’s halo is especially bright. She is an angel and true hero.”

In high school, Sonia Sutherland, MD, volunteered as a candy striper for her local county hospital, and since then has dedicated her whole career to helping her community and serving marginalized, underserved and minority populations.
 
Today, Dr. Sutherland is an internal medicine physician and the Medical Director of Detention Health at Contra Costa Health (CCH), where they provide care to 20,000 patients annually across four county jails. She also has served as Northern California’s physician for Hansen’s disease (leprosy), and provides direct patient care with respect and dignity to this unique population.  
 
Many patients in detention centers come from some of the most marginalized communities and have experienced stigma simply because of who they are and what they may or may not have done. “Someone once said that working with this population is one tangible way to start dismantling the legacy of slavery and racial oppression,” said Dr. Sutherland. “My goal is to restore the justice-involved population so that they may reunite with family and break the generational cycle.”
 
Dr. Sutherland recognizes that it can be a tough and challenging environment at times, and understands that compassion and the care of staff are just as essential to the compassion and care for patients.
 
She is one of the founders and co-leads of the Wellness Team, which supports the wellness of 4,000 CCH employees. What started as a vision to address physician burnout in 2019, was later transformed during the COVID-19 pandemic to be inclusive of the interdisciplinary team and opened to all staff.
 
With her dedication to supporting staff resiliency and growth—and because educational activities enhance patient care–Dr. Sutherland has helped expand resident involvement through elective rotations in forensic psychiatry and substance use treatment.
 
“Dr. Sutherland has always said that she tries to provide the best possible care for the patients at Detention Health, as these patients are probably receiving their first medical care, or they may not always get the appropriate care when they leave,” said a colleague.
 
To promote a healing environment, Dr. Sutherland works extraordinarily long hours advocating for patients through her clinical, administrative, and collaborative work with custody and detention health staff, and external providers to ensure patients receive the highest level of safe quality care that is timely, equitable and compassionate. She also personally visits patients cell-side to provide care and follow-up information to their questions, rather than send a note via the deputy or nurse.
 
“For me, Detention is not a place of last resort. It is a place of hope, compassion and respect,” said Dr. Sutherland. “There is great opportunity to impact our communities by simply extending a helping hand to those on the edge.”