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  1. Harkins, Deborah MBA, BSN, RN, CCRN

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As I thought about the best way to introduce myself to you, I decided that I really wanted to introduce you to someone else.

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I have an amazing friend. Her name is Eleanor Josaitis. Her personal story, gracious personality, and endearing qualities have profoundly affected me. And, she has profoundly affected many others.


Eleanor is the cofounder of Focus: HOPE, a $27 million-a-year social service organization in Detroit. She tells her personal story a lot, often beginning with something like this:


I can tell you the exact moment my life changed.[horizontal ellipsis] I was sitting in my living room watching the Nuremberg war crime trials and was appalled at what I was seeing. Suddenly, the program was interrupted by the civil rights march in Selma, Alabama. I watched as policemen rode through the crowd giving electroshocks, turning on fire hoses and letting dogs loose. I cried my eyes out. I asked myself-If I had lived in Germany during that time would I have pretended I did not see anything? What am I doing about what is going on in my own country?


Following that day in 1965, Eleanor Josaitis thought and prayed about what she might do to make a difference. In 1967, in the wake of the Detroit riots where 48 people were killed and more than 700 injured, this tiny, white, suburban housewife and mother convinced her husband that they should sell their suburban home and move to an integrated neighborhood in the heart of Detroit.


Long inspired by Dr Martin Luther King Jr, Mrs Josaitis teamed up with her friend and mentor Father William Cunningham, a young priest who taught English. He too moved to Detroit and accepted the call to a small Catholic church. Operating on the theory that there can never be equal opportunity without equal capability, Josaitis and Cunningham together founded Focus: HOPE (http://www.focushope.edu). They began with a food prescription program in 1971 for 1,000 children and pregnant/postpartum women. That program expanded to include senior citizens and is now one of the largest supplemental food programs in the country serving more than 44,000 people each month.


Josaitis and Cunningham realized that providing food was not enough, so they created a program to help move people from poverty to financial mainstream. They established a Machinist Training Institute to teach skills in precision machining and metalworking. Then, they opened the Center for Advanced Technologies to combat the lack of access to engineering education among minorities followed by an Information Technology program to provide industry-certified training in network, desktop, and server administration and a Montessori school to assist students with child care and provide quality preschool education to local neighborhood children. You want statistics on their success? The best place to start is their 100% job placement. To date, Focus: HOPE has grown to nearly 350 colleagues (they are not called employees), 51,000 volunteers, and a $27 million budget.


Happy endings? Rosey trip the whole way? The decisions Eleanor made in 1967 were meritorious to say the least. But, while her personal success and the success of Focus: HOPE are undeniable, the road was not easy.


When Mrs Josaitis picked up her family and moved to Detroit, her mother hired an attorney and tried to take her 5 children away from her, intimating that her desire to help the poor was evidence of irrationality and mental instability. Her brother-in-law asked her to use her maiden name so as not to embarrass the family.1


I often find myself in awe of what Eleanor has accomplished. My main reason for introducing you to her, though, is that she has divined a straightforward approach to dealing with challenge and change, and I cannot think of a better time for us in healthcare to consider how we deal with challenge and change.



One of my favorite business books is Good to Great.2 The author, Jim Collins, very elegantly discerns between organizations that have plateaued and organizations that have made the leap to go beyond, always striving for the next level. In his research, Collins found that the presence of genuine passion was a quality that set apart great companies. "You can't manufacture passion or 'motivate' people to feel passionate. You can only discover what ignites your passion and the passions of those around you."(p109)


Josaitis exudes passion. When she tells her story, she always says: "Find your passion and wrap your job around it." When the road gets hard, it is our passion for the work that keeps us going. If you find your passion wavering, maybe it is time to infuse new ideas or transform yourself-mentor new nurses, become expert in a specific clinical arena, write a journal article, go back to school or take a refresher course, realize a new career path in nursing, or make your own path. We have so many options!! Passion should be a gauge to let us know we are doing what we do for the right reasons.



"You never know where life will take you, sometimes you have to go around, over, up, or down to accomplish what you want. Don't get discouraged, that is just life."


Eleanor Josaitis


Over the past 40 years, Focus: HOPE has been steady in its mission and has reinvented itself along the way. They did not stop with the food bank, adding new training programs and continually improving. We need to be persistent in our aim to continually improve ourselves as well. Think about becoming involved in a hospital-wide committee or contribute your passion on the national level. The Society of Trauma Nurses has many areas with which to be involved including education, legislative, injury prevention, special interest groups, or teaching an advanced trauma care for nurses course (http://www.traumanurses.org). Likewise, if you find a clinical or process issue in your work environment, be persistent and work on solutions. Find a way to funnel your energy toward continuous improvement through clinical care committees, education, performance improvement, and offering new ideas. You will be amazed at what you can accomplish.



Eleanor speaks of a time when she was frustrated, trying to get the attention of the legislators after appearing 32 times before the Senate and the House. Through her connections and partnerships, she borrowed a plane from Ford Motor Company and flew legislators to Detroit to convince those in Washington, DC, that food programs should be extended to the senior community. After driving through the city streets in Detroit, the legislators understood. Eleanor was triumphant. The food program is now a national law.


Mrs Josaitis is keenly aware that we cannot go it alone. We need to rely on each other's strengths, learn from one another, and lean on others to make things happen. Only through everyone's imagination, courage, and creativity will we further change.


In healthcare (and life), having mentors and partnerships is key to developing our ideas, values, emotional energy, and overall career growth. It is important to identify and emulate those we admire.


The Society of Trauma Nurses is fortunate to have partnerships with the Eastern Association for Surgical Trauma, American College of Surgeons, and others. Through these relationships, we have forged new paths developing doctor of medicine/registered nurse trauma courses, answering research questions, and working to tackle trauma legislative issues. Combined, we have a powerful voice, far-reaching resources, and expansive knowledge. Likewise, we learn from one another.



Michaelangelo is credited with saying this: "The greater danger for most of us lies not in setting our aim too high and falling short; but in setting our aim too low, and achieving our mark." Focus: HOPE created the Fast Track and First Step programs to boost students who need remedial help before entering the machinist training programs. Fast Track and First Step programs have a 25% dropout or dismissal rate. This is a result of strict rules that are never bent. Drug testing takes place at the discretion of the instructors, and tardiness or unexplained absences are not tolerated. Lowering of standards for individual students is prohibited. While losing 1 in 4 students frustrates her, Eleanor says, "Never lower the bar. Raise it. Serious people will rise to it. We are in the business of giving people opportunities; it is up to them to take the ball and run with it."


Eleanor Josaitis takes people out of their comfort zone. She finds this vital. She purposely takes inner-city children to fine dining restaurants to teach proper etiquette, so they may never be caught off guard at an interview by all that silverware. If people are put in challenging situations, they learn how to deal with those circumstances and further their leadership skills.


Eleanor's example means an awful lot to me, particularly as the struggles of the US economy pour into healthcare.


For a while now, healthcare has seemed to be insulated. We have our share of issues of course, but it has been a safe haven of sorts. People will always need healthcare. True, but let us not kid ourselves: Hospitals and health systems are a business first and foremost. It has taken some time for healthcare to feel the effects of this economic downturn; the crisis has been knocking on our back door, and it is coming in whether we are ready or not. We can no longer control costs through carefully managed lengths of stay or thoughtful use of patient care protocols or working smarter. Decreasing reimbursement, dwindling elective procedures, increases in the uninsured population, reduced access to capital, higher cost of capital, and lower investment earnings from cash, pension, and endowment portfolios have led to hospital financial losses across the nation. In response, we are seeing health system layoffs, program cuts, leaner operations, less capital investment, and salary decreases. Hold on!! We are in for a long, bumpy ride.


How do we respond to this? What should we do? Can we even effect change in this environment?


As the old saying goes, the only constant in the universe is change. The more at home we are with that concept, the more clear we will be in working to solve the problems we see in front of us.


Following Eleanor's example, I would challenge you to step out of your comfort zone and do something that scares you or seems insurmountable. I did this myself a few years ago. I attended the University of Michigan's Ross School of Business for my MBA, while working full-time as a trauma program manger with young children at home. I was petrified to walk into a finance class, much preferring to hang another unit of blood in the trauma bay. Thanks to the support of my husband, friends, and colleagues; it was the best thing I ever did. I raised the bar, but also realized that no one can do these things alone.


Have we dealt with recessions before? Yes. Have we been through the cycle of layoffs and hospital-wide cutbacks before? Yes. Will we emerge on the other side better prepared and having learned many lessons? Yes.


Here are a few more bits of Eleanor's advice:


* Contribute wisdom and expertise.


* Surround yourself with good people.


* Put your ego in your pocket.


* Do not be afraid to ask questions.


* Find your passion.



I hope Eleanor's journey gives you food for thought. We must be motivated to continually improve ourselves and be passionate about what we do everyday. We have all been gifted with the ability to make a difference. And if we can, like Eleanor, become aware of that gift, we gain through the strength of our vision, the power to shape the future. That is our challenge. Bring it on!!


PS. You can read more about Eleanor Josaitis at http://www.focushope.edu/.




1. Tichy NM. The Leadership Engine. New York, NY: HarperBusiness Publishers; 1997. [Context Link]


2. Collins J. Good to Great. New York, NY: HarperBusiness; 2001:109. [Context Link]