The results of the recently published Health Forum/Samueli Institute 2010 Complementary and Alternative Medicine Survey of Hospitals found that the majority of hospitals that offered complementary and alternative medicine were urban hospitals (72 percent). Urban settings seem to provide the prime opportunity for offering CAM services — possibly due to the density of the population, but more likely due to the greater availability of providers in the community and the fact that most CAM professional schools tend to be located in urban areas.


Is there a reason only 28 percent of rural hospitals offer CAM modalities, or does this seem logical given that rural areas tend to be underserved by even conventional health care providers? Is it because there are fewer CAM providers available, or because market differentiation (one of the key reasons for hospitals to offer CAM services) may not be an issue for rural hospitals? How can rural hospitals take advantage of their unique situations and integrate CAM therapies into the care they provide while serving the needs of their communities?

In examining these questions, we found there are no easy answers. We compared urban and rural hospital data from the 2010 survey and found, among other discoveries, two interesting points: First, rural hospitals were less likely to list "organizational mission" as one of the key reasons to offer CAM services (rural: 42 percent; urban: 63 percent). Second, administrators in rural hospitals tend to be the champions for the CAM program more often than in urban settings (rural: 78 percent; urban: 52 percent).

More Choices for Rural Patients

Mid-Columbia Medical Center, in rural The Dalles, Ore. (a Planetree hospital since 1992), was the first institution in the world to implement the Planetree philosophy facilitywide. In addition to complementary and alternative therapies that are offered on both an inpatient and outpatient basis for patients and families, the philosophical and cultural shift toward patient-centered care was driven by former CEO Mark Scott and current CEO Duane Francis, says Barbara Robison, director for mind-body medicine at the hospital. With their passion and vision, and the support of their board, this small, rural hospital has become a leader in whole-person care (mind, body and spirit) and has attracted thousands of site visits by hospital administrators, physicians and nurses from all over the country.

Joyce Powell-Morin, R.N., M.N., chief culture officer, says that this distinction not only has attracted patients from throughout the state, but also helped with staff recruitment and retention. What has been most rewarding for Powell-Morin (who has been with the hospital for 38 years) has been watching the evolution of Mid-Columbia into a healing institution. The process brought many therapies and modalities like reiki, massage and aromatherapy to this small farming community, and Powell-Morin is pleased to see patients embrace these practices.

Involving Physicians and Volunteers

Grinnell Regional Medical Center, located in east-central Iowa, began developing its integrated health center at the Postels Community Health Park more than a decade ago. The institution focused on hospice services as a way of easing into the CAM therapies and introducing their benefits to the medical staff; in time, massage, music and aromatherapy all were provided to hospice patients. Members of the medical staff also were offered a complimentary massage, which provided them firsthand experience of the benefits of CAM therapies.

Tapping into the talents and gifts within the community became a successful strategy to expand the program. For example, several times each week Grinnell College and Grinnell High School students sing and play music for patients. The hospital's arts advisory council — which consists of art professors and other community members dedicated to the arts — helps to raise funds, chooses art for the permanent collection and arranges showings of local artists in the gallery areas. Local dog enthusiasts bring their specially credentialed pets to the medical center weekly to delight patients and staff. Every community has skilled and talented community members looking for opportunities to help make a difference in the world; institutions easily can tap into these resources for whole-person care.

Over time, CAM therapies have been introduced into the hospital's inpatient services. For example, by offering patients a preoperative complimentary massage, patients reported decreased anxiety and increased satisfaction. The hospital also reported a reduction in the use of anesthetic agents and pain medicine for these patients.

Rural hospitals have unique challenges in implementing integrative health strategies. But with some creativity and the support of the local community, these hospitals can become a true center of healing for their communities.

Sita Ananth, M.H.A., is the director of knowledge services at the Samueli Institute in Alexandria, Va., and a regular contributor to H&HN Daily.Todd Linden, F.A.C.H.E., is the president and CEO of the Grinnell (Iowa) Regional Medical Center, and a member of the Health Forum Board of Directors and Speakers Express.