Innovative Care at Haywood Regional Health and Fitness Center

December 5, 2016


Background of STEP Program: STEP is focused on individuals with chronic medical conditions who need to integrate exercise and weight management into their treatment program to successfully manage their health. Examples include: heart and lung disease, diabetes, cancer recovery, bone and joint conditions, obesity and general deconditionin




1. What is the innovation?

Dr. Kate Queen:

The STEP Program is an innovative approach to incorporating exercise into chronic disease management. Participants who enter the STEP program are first seen by a member of our physical therapy team for a one-on-one evaluation. Physical therapists are movement experts and their input is very important to the participant’s success.  This evaluation is typically covered by standard health insurance plans. Some participants have needs that should first be addressed with additional physical therapy visits before they move on to the exercise physiologist.

We have 2 exercise physiologists on our team who have academic training in exercise science with extensive clinical training, and certification. They are experts in developing an exercise prescription and have the skills to guide individuals in implementing those exercise plans.

One of our exercise physiologists is certified to work with patients with malignancies. There is strong evidence that patients with a new diagnosis of malignancy do much better with their recovery from surgery, chemo and radiation therapy and also survive longer if regular physical activity is integrated in their program of care Dr. Al Mina was the lead surgeon who helped us with our pilot program for patients with recent diagnosis of malignancy.

After the patient has seen the physical therapist and has been evaluated by the exercise physiologist, they then become a member of a small group of 4-6 individuals with similar fitness levels and begin a 60 day program of exercise meeting twice a week, under the guidance of their exercise physiologist. The cost of this 60 day program is $60 and in addition includes 4 group sessions with our registered dietician and use of the facility for any other activities they wish to try.

Our goal is that, by the end of their 60 day program, these individuals are independent in their program of exercise and ready to become members of Haywood Health and Fitness because they understand the importance of continuing their exercise commitment, and recognize that there are a wealth of resources available to them as members to support them in reaching their fitness goals.

Dr. Al Mina:

The STEP Program was Kate’s vision, and I’m so grateful to have her as the visionary behind this. From my perspective as a surgeon, to be able to change a patient’s old habits and get them into some type of daily or weekly physical activity, combined with physical therapy, and help from a dietician, it’s wonderful. I’ve had several cancer patients who are here every week and it’s going to be better for their cancer recovery and in the long term.



2. What were the reasons that you launched the innovation?

Dr. Kate Queen:

The STEP Program has grown out of a long term commitment at Haywood to offer our community a continuum of care beyond emergency, acute care services and standard outpatient services.

We now aspire to the goal of helping our medical providers infuse physical activity into the management of all chronic diseases because we believe all chronic disease care demands that approach be integrated.

The STEP program is not just designed to meet the exercise needs of patients with a recent diagnosis if malignancy but to meet the needs of individuals with arthritis, osteoporosis, depression, cardiovascular disease, and diabetes. In fact, I would challenge you to name a chronic disease that would not benefit from incorporating exercise into the program of care.



3. What key lessons did you learn along the way? What worked? What didn’t?

Dr. Kate Queen:

We know that for many of our participants it was a big challenge to cross the threshold and come into the fitness center on the first day because many of them had never been in that environment before. We have been delighted with how many of them have overcome their apprehension, successfully completed the program and transitioned to membership. Having all of our professional team working under one roof has helped us transition our participants to the next level. We are continuing to work on engaging our medical staff in referring their patients to this program, and other programs that are available to meet the needs of special populations.

We also have learned how important it is to help our participants identify their own goals for making the commitment to exercise, and to set appropriate goals for the first 60 days of that commitment.

4. What are the impacts/outcomes of the innovation?

Dr. Kate Queen:

We have been monitoring on entry and at completion the impact of our program using objective measures of physical performance (i.e. gait speed, timed chair rises) and also measuring, by way of questionnaire, the impact of the program on issues including self-efficacy and fatigue.

We have been very pleased with the growing number of patients referred to the STEP program and the fact that approximately 85% of our STEP graduates to date have become fitness center members.

Dr. Al Mina:

We (physicians) can’t do everything ourselves, and you get behind. So when you can refer your patients to a program like this, it really helps them. Because there are so many different facets we can do in this building, we can accommodate many types of rehabilitation and healing. Patients are able to receive continuous post-surgery care, and that’s important for their full recovery.


5. How will this innovation help you handle or manage various aspects of healthcare reform?

Dr. Al Mina:

The main thing about (healthcare) reform is that we’re going to try and be more outcomes based. So if the STEP program will help the community become healthier, they’ll be in the hospital system less. You won’t see as many people with chronic health conditions or needing surgeries.


6. Who were your primary influencers and mentors in creating this innovation?

Dr. Kate Queen:

This vision has been shared and enhanced by many over the years since the Health and Fitness Center was built, but our rehab and fitness center staff are central to this dream, as have been key leaders in the medical staff. We are delighted that our current hospital administration understands how powerful this component of care could be to enhancing the health of our community.

7. In what ways does this innovation improve the physician-patient relationship?

Dr. Kate Queen:

This program offers the busy provider the opportunity to refer their patient for the care they know they need, but that has been difficult to find. Now they know that with a simple referral we will provide a high quality professional service to meet the physical activity needs of each individual.

We also sense that patients appreciate the broadminded approach to their health wellness.

Dr. Al Mina:

It’s nice as a surgeon to have this type of program in place. I typically follow my cancer patients for a minimum of 5 years. This program helps build that relationship and witness their progress.

8. In what ways does this innovation influence the joy and meaning you find in medicine?

Dr. Kate Queen:

As a rheumatologist, I have always been an advocate of rehabilitation services and physical activity in the management of the diseases I treat. I am delighted to be practicing in an era where we now have the evidence to show what a powerful and necessary tool physical activity is if we want our patients to thrive and survive, and that we have a real obligation to see that it is integrated into the way healthcare is delivered.

This opportunity provides a way for me to build on what I’ve always believed in. In a time of change when there are plenty of things to feel frustrated about with the healthcare delivery system – it is very satisfying to be working on new solutions and systems of care with the potential to better address the changing needs of our patients and our community.

Dr. Al Mina:

You just get that much closer to your patients. They are appreciative and it gives you satisfaction as a physician.



9. What advice would you give to others interested in implementing your innovation?

Dr. Kate Queen

We are very fortunate at Haywood to have a spectacular facility and team that works together in one organization and under one roof. This same work can be done in other communities, but the challenge will be engaging all the stakeholders who share the vision and have the professional expertise to develop the continuum of care that delivers similar kind of evaluation and management and consistently advances the patient from evaluation to engagement in a regular ongoing program of exercise.

Dr. Al Mina

You have to rely on the people around you. This cannot be a one person program. It’s a combined effort of physicians, community leaders, dieticians, etc. You also need to convince the hospital administration that this is the right thing to do.