The Wall Street Journal-20080216-Encore -A Special Report-- Profiles in Retirement
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Quality
In Health Care
In the mid-1980s, Donald Berwick, a pediatrician and vice president of a health-maintenance organization in Massachusetts, discovered what would become his life's work.
Asked by his HMO to study how private industry developed safety and quality-assurance programs, he began interviewing people at International Business Machines Corp., Bell Labs, Toyota Motor Corp. and Gillette Co., among other large organizations.
"What I saw . . . blew me away," Dr. Berwick recalls. "I realized the health-care industry was a century behind in terms of applying scientific, systematic measurement systems to their work." Adopting the same practices in medicine, he reasoned, could "save millions of lives."
Today, at age 61 and eight years retired from private practice, Dr. Berwick is chief executive of the Institute for Healthcare Improvement, a nonprofit he co-founded that's dedicated to enhancing patient safety world-wide.
"As a doctor, I saw every day the deep problems in hospitals with the quality of care -- waiting times for operations, infection rates, and test results that were never pursued," Dr. Berwick says. "People were dying because of these things, and they were so easy to fix."
Dr. Berwick graduated from Harvard University in 1968 with a degree in social relations and later obtained his medical degree and a master's in public policy. During his early career, he spent half his time in an academic post at Harvard, teaching clinical pediatrics and health-care policy. He still teaches several classes at the university.
In 1980, Dr. Berwick accepted a post as research director and pediatrician with the Harvard Community Health Plan, a now-defunct HMO. The organization was losing money and needed to know why. So, in 1983, Dr. Berwick was appointed vice president of quality-of-care measurement. From there, he began his research with private industry. He left the HMO in 1989 and retired from practicing medicine 10 years later.
The Institute for Healthcare Improvement, based in Cambridge, Mass., started out as a small organization aimed at reducing unnecessary patient deaths by encouraging hospitals to implement standardized safety practices. Today, the institute has more than 100 employees and an annual operating budget of $40 million. Most of that money is generated by fee-based work, but about 15% comes from grants. That enables the group to hold an annual conference on health-care safety, for more than 6,500 attendees, as well as offer educational programs to help medical providers improve the quality of care.
The institute, which has persuaded more than 3,000 hospitals nationwide to implement its safety practices, says its program has helped save more than 120,000 lives that otherwise would have been lost due to medical mishaps.
Dr. Berwick regularly travels to Europe and Africa, where he is working to get his medical guidelines adopted in some of the world's poorest countries. In the U.K., where Dr. Berwick has helped improve care in the National Health Service, Queen Elizabeth II made him an honorary Knight Commander in the Order of the British Empire.
"I could no longer just sit back and not try to change what was wrong with health care," says Dr. Berwick, who has four grown children and has been married for 31 years. "Bringing social change to a massive industry is a big job, but it's one where innovation, collaboration and joy come together."
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A Music Man
To Transform
Schools
At 91 years of age, Gene Jones often spends his days listening to opera with 7-year-olds.
A great-grandfather, he is the founder of Opening Minds Through the Arts, a nonprofit based in Tucson, Ariz., that promotes music, dance and related disciplines at public schools to help improve academic performance.
Mr. Jones first retired in 1978, but soon grew bored and started working again as the head of a real-estate company. A lover of classical music, he attended the American Symphony Orchestra League convention in 1998. After hearing a presentation on how the Winston- Salem Symphony in North Carolina had brought music into schools and dramatically turned around students' academic performance, Mr. Jones wanted to do the same thing in Tucson.
"I am not a teacher, and I'd never been involved in education," Mr. Jones says, "but when I saw how music changed these kids' lives, I knew I had to do something." He went back to Tucson and started talking to educators and doing research. He started Opening Minds in 1999, and created a separate foundation to fund the organization in 2003.
"Here was this 84-year-old guy, barging into school-board meetings, saying I wanted to completely change the way they taught," Mr. Jones recalls. "So you can imagine that, at first, the district was very reluctant."
Today, about 19,000 children at 44 elementary and middle schools in Tucson benefit from Opening Minds, which requires participating schools to adopt an arts-integrated curriculum to reinforce reading, writing, math and science. Teachers at Opening Minds schools weave fine art, theater, dance and music into the curriculum -- using musical notes to teach fractions, for instance, or asking students to compose operas to hone their writing skills. The organization also employs 50 local artists and musicians who teach twice-weekly classes.
So far, results have been encouraging: After three years in an Opening Minds program, students across all ethnic groups found their standardized test scores to be significantly higher than those in other schools. Mr. Jones is working to persuade schools nationwide to adopt his program.
Mr. Jones graduated from Dartmouth College in 1937, after paying his way through school by selling shoes to classmates. He turned down Harvard Business School (he says he couldn't afford the tuition) and ended up in the Air Force. At the end of his service, Mr. Jones bought a struggling manufacturing business, turned it around and sold it for a profit. He has done the same with a number of companies and sold his final business in 2007 at the age of 90.
To date, Opening Minds has received more than $5 million in grants from the Department of Education, and Mr. Jones has committed $1 million of his own money to the organization. The group has six employees and relies on volunteers to help train teachers.
Mr. Jones, whose goal is to "forever transform the educational system in America," says he plans to keep working at Opening Minds until he is physically unable to get to the office.
"There are two types of retired people," he says. "Those with too much time on their hands who sit around and complain, and those who are making a difference. I'd like to hope I'm one of the latter."
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Training Dogs
For Life
Wilma Melville started dabbling in dog training as a hobby 15 years ago. But after she spent a week with her Labrador, named Murphy, combing for survivors amid the rubble of the Oklahoma City bombing in 1995, her hobby became a calling.
At the time, there were only 15 search dogs in the U.S. that had been certified by the Federal Emergency Management Agency. Murphy was one of them. "Here were these people buried alive, and there were just a few dogs to help find them -- some of which had no special training," says the 74-year-old Ms. Melville. "I realized how many more people could have been saved if we had more specially trained search dogs."
To that end, Ms. Melville in 1996 founded the National Disaster Search Dog Foundation. The nonprofit takes abandoned dogs from shelters, trains them in about eight months using a program developed by Ms. Melville and a professional trainer (other methods typically take two to three years) and pairs the animal with firefighters to be deployed in the event of a disaster. Firefighters who take part in the program receive free training from the foundation to learn to work with their dogs.
To date, the group has trained 85 dog-firefighter teams, which have helped search for survivors in New York after the Sept. 11 attacks, on the Gulf Coast after Hurricane Katrina, and in the aftermath of fires, earthquakes and mudslides.
Ms. Melville spent her early years in Los Angeles, working as a physical-education teacher while raising four sons. When she retired in the early 1980s, she moved to Ojai, Calif., and bought a small ranch, where she kept horses and rode competitively in long-distance races for several years. On occasion, she would find training techniques in books and try them on her German shepherd, Topa.
But, in the early 1990s, she met Pluis Davern, a professional dog trainer. "Pluis taught me the three things needed to train a disaster search dog: the right dog, matched with the right handler, and professional training for both."
Ms. Melville took those words to heart, found a new dog, Murphy, and started driving 10 hours round trip twice a month to work with Ms. Davern. She trained Murphy a few hours a day until he was ready to take the FEMA certification test.
The same intensive approach used to train Murphy is the cornerstone of the National Disaster Search Dog Foundation. The organization now has eight employees who help find dogs, implement training and facilitate matches with firefighters.
Today, Ms. Melville spends about 20 hours a week working with the foundation, but has stepped aside as executive director to devote time to her other passion: flying. She recently moved from her Ojai ranch to Santa Paula, Calif., to be closer to an airport.
"After Oklahoma City, I did what I did because I knew I could make a real difference," Ms. Melville says. Her greatest reward, she adds, comes from watching the bond develop between a dog and handler and knowing the two will probably save many lives. "We remove a seemingly useless animal from a threatening environment and, with training, turn that animal into a joy to many."
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Fighting for
Foster Children
In a 40-year career working with foster children, Gordon Johnson experienced firsthand the limitations of state-run foster-care systems. Chief among them was watching siblings placed in separate homes -- families ripped apart.
That's why in 2000, at the age of 67, Mr. Johnson started Neighbor to Family, a nonprofit agency that works in cooperation with state-run programs to keep siblings together in foster care. The organization, based in Daytona Beach, Fla., also has pioneered other initiatives, including paying foster parents a salary and giving them health benefits. So far, Neighbor to Family has helped 4,500 children, 4,100 of whom were siblings placed together.
"In my career," says Mr. Johnson, who is now 74, "I saw many kids being taken from wretched situations and put into even worse situations; it was hard to stomach. That's why I developed a methodology to keep siblings together and try to get them home as fast as possible, which should be the norm, but it isn't."
Mr. Johnson has dedicated his life to helping children, even at the cost of moving his own family from state to state throughout a long and varied career in foster-care administration. After graduating from Thiel College in 1958, Mr. Johnson spent two years in the military and then took his first job as a "cottage director" at the Jamesburg State Home for Boys in New Jersey.
From there, Mr. Johnson worked in a succession of residency programs for troubled children in a half-dozen states. His last job was president of Jane Addams Hull House, which offers foster-care services, domestic-violence counseling, housing assistance and job training to 60,000 people in the Chicago area. He retired in 2000.
"It's from all of those experiences that I built what I do today," Mr. Johnson says. "I was directly in charge of so many children who were not safe, who were abused and neglected, and it really hit home that I was, in large part, responsible for their lives."
While still working at Hull House, Mr. Johnson laid the foundation for Neighbor to Family. After retiring, he moved to Florida and officially founded the organization. Today, Neighbor to Family has more than 600 employees and a $36 million annual budget; it operates in Georgia, North Carolina, Maryland and Virginia, as well as Florida.
"Our approach is fairly radical, because we go against the accepted grain," Mr. Johnson says. For one, all Neighbor to Family foster parents are employees of the organization, with a modest salary, a 401(k) and health insurance, whereas typical foster parents are volunteers. These foster parents must meet regularly with counselors, case workers and the children's biological families to develop plans for reuniting children with family members as quickly as possible.
The approach has achieved heartening results: On average, Neighbor to Family children spend six to seven months in foster care, compared with the national average of 33 months.
"I don't think I could ever really retire, I have too strong an obsession with helping kids," says Mr. Johnson, who is working to spread his program to all 50 states.
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Know-How
For Hispanic
Entrepreneurs
Sara Gonzalez, age 72, knows precisely what she plans to do in retirement: help Latino entrepreneurs build successful companies.
It's something she has already been doing as president and chief executive of the Georgia Hispanic Chamber of Commerce. It's not just a job, she says; it's a passion. That's because Ms. Gonzalez, too, was an entrepreneur; she once ran a Cuban restaurant that ultimately failed because she had no idea how to operate a business.
"Every day, I see so many Latinos who are desperate to work and create businesses that help them build better lives for their families, and I can't imagine a life where I wasn't helping them succeed," Ms. Gonzalez says. "So even when I retire from this job, I'll do something to help Hispanic entrepreneurs."
Ms. Gonzalez immigrated to the U.S. at the age of 24 in 1960, fleeing Cuba with her husband and two young children after Fidel Castro came to power. The young family landed in New York, and Ms. Gonzalez thought they would stay for about six months until things blew over in Cuba, and then go home. "We were staying in a hotel and the kids found it all very exciting, seeing snow for the first time and playing in Central Park," she says, "but then one day it dawned on me that we weren't going back."
Ms. Gonzalez and her husband eventually divorced. After moving to Florida and remarrying, she settled in Atlanta. There, Ms. Gonzalez struck upon the idea of opening a Cuban restaurant. "I was very optimistic, but I had no background in business and didn't do any market research," she says. "I soon found out Atlanta in 1978 wasn't ready for an authentic Cuban restaurant."
The business failed, and Ms. Gonzalez once again was on the job hunt. She landed at the local branch of United Way as a Spanish- speaking receptionist. That job changed her life.
"Hispanics were showing up in Atlanta in droves, and I realized I could help them and make a difference in their lives," she says. She soon was appointed community-relations manager and found she had a talent for fund raising. A few years later, Ms. Gonzalez was approached to work as the head of Hispanic community relations for the Atlanta Committee for the Olympic Games, helping the organization raise sponsorship money from Hispanic-owned businesses. During her four years with the Olympics, Ms. Gonzalez worked regularly with a then-fledging organization, the Georgia Hispanic Chamber of Commerce. When the Games ended, the chamber asked her to become president.
Today, Ms. Gonzalez spends almost as much time on the road as in Atlanta, helping to raise corporate sponsorship money. Recently, she started a small-business incubator at the chamber, allowing Latino entrepreneurs to use office space and support staff. The chamber also offers seminars on almost 80 different topics that help people learn to run a business. Hundreds of people take part in the classes. Last year, more than 160 went on to start their own firms.
"I wish I had known all those years ago what I know today, then my business may not have failed," Ms. Gonzalez says. "I tell people every day, 'It's not enough to have a great idea; you also need to know how to build and run a business.'"
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Helping
At-Risk Moms
Get Started
Sometimes, the simplest solutions can help solve the biggest problems. Working as a neonatal nurse for 16 years, Sharon Rohrbach saw too many babies leave the hospital healthy and then return soon after with life-threatening conditions caused by neglect. So she started the Nurses to Newborns Foundation in 1992, an organization that sends nurses into the homes of at-risk mothers to provide parenting education and emotional support, as well as diapers, food and clothes for their babies.
"When you watch a baby die in its mother's arms, it is a huge motivation to change what isn't working," says Ms. Rohrbach, who lived that terrible experience multiple times during her nursing career. "I just couldn't sit back and do nothing to help these children, who were dying from preventable problems."
Ms. Rohrbach, now 65, started her nursing career in 1976. She grew up in St. Louis, got married at 17 and raised four children, working part time as a secretary. When her children were older, she went back to school to get her nursing degree and landed in the neonatal unit at St. Anthony's Medical Center in St. Louis. She soon realized that babies born to young or low-income mothers were more likely to wind up back at the hospital with infections, jaundice and other maladies.
Thinking most of the problem stemmed from the fact that women were discharged after 24 hours, before many of the problems like jaundice could be detected, Ms. Rohrbach started Nurses for Newborns to provide nursing care for mothers and babies after they arrived home.
At first, she ran the organization -- part time while still working as a nurse -- as a for-profit company, hoping to get insurers to cover the cost of the home visits. But that proved difficult. Then, in 1991, the state of Missouri gave Nurses for Newborns $50,000 to provide its services to poor, uninsured mothers.
Seeing firsthand how poor mothers lived, Ms. Rohrbach felt compelled to change the focus of the organization. "I walked into these women's homes, and I realized right away the length of time they stayed in the hospital was the least of their problems," she says. Many of the babies were living in cramped, unheated houses, didn't have a crib, and had no warm clothes or even diapers. Many of the mothers were addicted to drugs, victims of abuse or had a history of mental illness.
In 1992, Ms. Rohrbach turned Nurses for Newborns into a nonprofit organization. Nurses visit at-risk mothers and babies in their homes, bringing food, clothes, diapers and personal-care items, and helping them with basic parenting skills.
The results have been highly encouraging: There are far fewer hospitalizations, compared with babies who are not followed by the program; no reported cases of neglect or abuse; few injuries; higher immunization rates; and fewer repeat pregnancies.
"I didn't know anything about running a nonprofit, I was just trying to save babies' lives," says Ms. Rohrbach, who left her nursing job in 1991 to devote herself full time to Nurses for Newborns.
The organization has served more than 50,000 families in Missouri and Tennessee. With 75 employees and a $3.6 million annual budget, Nurses for Newborns is now nationally recognized for its innovative work helping reduce infant mortality. Ms. Rohrbach travels 30 weeks a year; writes 52 grants applications a year, with a goal of raising at least $8,000 a day; and does advocacy work for the uninsured on state and federal levels -- a pace she admits is exhausting.
She plans to step down from her post as chief executive of Nurses for Newborns by the end of 2009 to focus on a new company she has founded, Dynamic Change, which will offer consulting to nonprofits to help them better serve vulnerable populations. She'll continue to work with Nurses for Newborns as a consultant, with the goal of expanding the program nationwide.
"I . . . plan to take things a bit more slowly," Ms. Rohrbach says, "choosing how to best use my skills to help the greatest number of people."
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Profiles in Retirement, a regular Encore feature, looks at the varied paths people are taking in later life. In this issue, we focus on recipients of the Purpose Prize, given annually to individuals age 60 and older who are tackling some of society's biggest challenges. The awards are presented by Civic Ventures, a San Francisco-based nonprofit working to expand the contributions of older Americans. The profiles are by Kristi Essick, a writer in California. You can send your comments about them -- or how you're spending your own time in retirement -- to [email protected]. We'll do our best to share your stories in these pages.
