The Mary Washington Healthcare Oral History Project recorded 100 hours of interviews with forty-five people on the history of health care delivery, hospital-based medicine, and Mary Washington Healthcare (MWHC). The interviews were conducted with board members, administrators, physicians, nurses, social workers, and community members. Beyond a story of expansion or a single organization, the interviews recorded successes and ongoing challenges with the transformations in health care and hospital-based medicine over the last thirty years.
Since opening the new Mary Washington Hospital in 1993, MWHC has transformed itself into a regional medical center and health care delivery system. MWHC is the preeminent health care institution in the greater Fredericksburg region. Rooted in Mary Washington Hospital, which had eight rooms when it opened 1899, MWHC now encompasses Mary Washington Hospital, Stafford Hospital, and twenty-eight other healthcare facilities. Mary Washington Hospital has 437 beds and is the anchor of a regional medical campus.
MWHC is first and foremost a health care provider, but it is a vital part of the region’s economy. It is the largest non-government economic engine in the Fredericksburg region. MWHC employed over 4,300 people in 2010, up seventeen percent from 2005. MWHC is major source of the economic activity in the Fredericksburg region. Its combined economic impact represents nearly four percent of the region’s economy.
Health care is a sector of the economy that sustained growth during the 2007 to 2009 recession and the era of slow economic growth that has followed the worst recession in the United States since the Great Depression. Embedded in the history of Mary Washington Healthcare are vital public policy, economic, social, and political concerns. Health care, public policy, and regional development all intersect with local, state, and federal government interactions to affect health care delivery and economic growth in the greater Fredericksburg region.
This project documents how MWHC became more involved with primary care medicine and public health while shifting from a community hospital into a tertiary care medical center. MWHC’s history and expansion has links to key objectives in the Patient Care and Affordable Care Act (Affordable Care Act (ACA) or Obamacare), such as clinical integration and the development of Accountable Care Organizations. The history of MWHC since the late-1980s illuminates how hospitals and an expanding health care organization contributed to public health and primary care medicine.
The interviews allow for critical exploration of how hospitals can benefit health care delivery beyond acute care and provide community benefits in a multitude of ways. The project documents how MWHC’s commitment to community benefit, public health, and primary care has important links to aspects of health care reform currently underway in the United States.
Jess Rigelhaupt, the principal investigator, designed this project to document the history of MWHC’s expansion and record the recollections of people involved with its transformation. There were three central themes in the project.
What are the core values of Mary Washington Healthcare? How were they developed and sustained during times of expansion? How have the core values and systems at MWHC shaped health care delivery and practices in the Fredericksburg region? What new practices had to be implemented in the transition from a community hospital to a tertiary care hospital and a diversified health system? How have the core values, practices, and culture at MWHC been shaped by the relationships between the board of trustees, the administration, and the medical staff?
Business Model and the Economics of Health Care
How did Mary Washington Healthcare develop its business model? In what ways was the business enhanced, tested, and altered during the last twenty-five years? What were the internal debates, priorities, and decision-making processes? How have changes in Medicare and Medicaid reimbursement affected MWHC? How have changes in third party payors (private health insurance) affected MWHC? How did the expansion of Health Maintenance Organizations (HMOs) and managed care programs affect MWHC? How have new technology and the information revolution impacted the economics and delivery of healthcare? What role has the integration of hospitals and physician practices played in MWHC’s history?
Governmental Relations and Health Care Public Policy
What are the interactions between MWHC and federal, state, and local government regulations and programs? How have laws and regulations affected MWHC and health care delivery in the region? How has health care as a political issue affected the practice of medicine? How will the Affordable Care Act (ACA) impact MWHC?
Oral history is uniquely suited to purse these questions because practitioners of oral history recognize that it is a shared authority: it relies on the research and questions of the interviewer and the memories, narration, and expertise of the interviewee. The interview represents contributions from both interviewer and interviewee. It is shaped by both the interviewer’s questions and interviewee’s memories and narration.
Not-for-profit hospitals and hospital-based medicine are also a shared authority between the administration, the medical staff, and the community-based board of trustees. The administration, medical staff, and board of trustees are all essential to hospitals, but no group of physicians, nurses, administrators, or board members could run a modern tertiary care or community hospital alone. The complexity of modern medicine and hospital-based medicine requires a broad range of expertise. Board members, administrators, physicians, nurses, and hospital staff must work together to provide patient care and manage the hospital.
The human relationships at the center of medicine and patient care influence hospitals, and the importance of relationships are emphasized across the interviews. The ways in which people—community board members, administrators, physicians, and nurses—worked together are essential to understanding the history of MWHC. The shared authority of hospitals and the relationships between the board of trustees, the administration, and the medical staff includes disagreements, distrust, and challenges. Expansion and introducing new medical services, for example, involve planning and dynamics that go beyond business plans, the latest technology, and may not be detailed in the documentary record. The interviews allow people to speak for themselves and document memories of events, planning, and decisions that took place behind the scenes.
Statement of Academic Independence
Although MWHC provided funding, this project was developed and executed as an independent scholarly research project. MWHC assisted with developing a list of potential interviewees. The interviewers had complete discretion on the questions that were asked during the interviews. After the interviews, the transcripts were sent to the interviewees for their review. Interviewees had the opportunity to seal portions of their interview or remove themselves and their interview from the project. After reviewing their transcripts, interviewees were asked to sign a legal release that transferred copyright of the interview to the University of Mary Washington. The video recordings and interview transcripts were not made available to MWHC or the public until after interviewees reviewed their transcript and signed a release.
The transcripts are the final records of the interviews in this oral history project. The final transcripts are lightly edited for readability and include changes requested by the interviewees. During the transcript review process, interviewees may have added names of people or corrected information. The transcripts reflect the conversation during the interview, but they are not a word-for-word reproduction. Small changes for readability and narrator requested changes were made to the transcripts.
I would like to thank the narrators. All of the people interviewed for this project were generous with their time and commitment to reflecting on and recalling decades of history. It is hard work to be interviewed and the interviewees embraced the process. They made a significant contribution to documenting the history of MWHC and health care delivery in Fredericksburg.
This project would not have been possible without financial support from Mary Washington Healthcare, the University of Mary Washington (UMW), and private donors.
I would like to thank MWHC’s Marketing and Communications Department and Debbie McInnis for supporting this research project. Providing a list of potential interviewees and assisting with meeting spaces was crucial for advancing the oral history interviews.
I received support from the Department of History and American Studies, especially with administrative hurdles associated with implementing the project.
UMW’s Division of Teaching and Learning Technologies (DTLT) supported this project from its inception. It was a pleasure working with everyone at DTLT, including Jim Groom, Martha Burtis, Andy Rush, Tim Owens, and Ryan Brazell. Andy Rush provided invaluable counsel on Final Cut Pro, video editing, and managing HD video. Tim Owens and Ryan Brazell assisted with developing the website.
Suzanne Chase, UMW’s Digital Resources Librarian, (and now the Digital Services Unit Head at Georgetown University) helped with developing Dublin Core Standards, cataloging the transcripts (in process), and archiving the transcripts and video.
As I was formulating the project, I discussed it with my former colleagues in the Oral History Center of the Bancroft Library at the University of California, Berkeley (formerly known as the Regional Oral History Office). Martin Meeker, Director of the Oral History Center and lead interviewer on the Kaiser Permanente Oral History Project, shared his experiences on the Kaiser project and offered guidance for health care focused oral history research. His ideas and the Kaiser project became models for this project. Richard Candida Smith, former Director of the Oral History Center and Professor of History (Emeritus) at the University of California, Berkeley, supported this project. Through numerous consultations, he shared his expertise with developing and managing multi-year oral history projects and implementing oral history projects within the structures of a university.
I was pleased to be able to integrate this project with my classes and UMW’s educational mission.
In spring 2013, I taught Health Care Oral History (AMST 350M). The eight students in the class—Josephine Appiah, Arielle Carrick, Michael Corrigan, Kelly FitzGibbon, Hannah Laughlin, Kelsey Matthews, Kendall Simonpietri, and Jared Smith—had all taken my Oral History course (HIST 441) the previous fall and were prepared to undertake more advanced oral history research. The course studied the history of medicine, health care delivery, and hospitals in the United States in conjunction with oral history and memoir on these topics. As a collaborative research team we used this research and study to develop interview themes, outlines, and questions for this project. Each student conducted an oral history interview for this project. In addition, each student had to produce a short documentary film driven by their own interviews on some aspect of health care in the United States. The documentaries focused on a range of topics, including having a grandparent with Alzheimer’s, becoming bone marrow donor, and disaster preparedness at a community hospital.
In spring 2014, I had the good fortune of working with three wonderful students—Amanda Vercruysse, Dana Nordling, and Stephen Campbell—through UMW’s Undergraduate Research Program. They were an excellent research team and provided valuable assistance with identifying trends in the interviews, video editing, transcript editing, and website design and development.
In fall 2014, I integrated the MWHC Oral History Project into my Oral History seminar (HIST 441). Students were trained in oral history methodology and conducted individual interviews with a family member. In addition to oral history methods and studying the life history tradition in oral history, the class had a focus on the history of nursing in the United States since the 1950s and documenting experiences of health care practitioners, especially nurses. Students in the class conducted an interview with a nurse at Mary Washington Hospital or Stafford Hospital. The students and I conducted joint interviews with the nurses and the students did a great job with the interviews. It was rewarding to witness students conducting professional oral history interviews and their interactions with nurses during the interviews—this seminar and the joint interviews were among the best experiences I had while teaching at UMW. I appreciate the students in the class—Myra Carr, Austin Clay, Marie Clifford, Courtney Dickerson, Abigail Fleming, Jacqueline Geddis, Jordan Harmer, John Holwick, Grace Mann, Jack Manning, Ellen Peiser, Andrew Perrow, Shauna Sanford, and Christian Zapatero—and I am grateful for their hard work and contributions to this project.
In spring 2015, Abigail Fleming, Grace Mann, and Ellen Peiser, who were in my oral history seminar the previous semester, worked on this project as an undergraduate research team. They were an outstanding research team and it was wonderful working with them throughout the semester. Abigail Fleming created a vital new research track with her focus on the role of social workers in a health care system and the history of care management at Mary Washington Hospital. She conducted four interviews with staff members in the Care Management Department. Grace Mann and Ellen Peiser made important contributions to the project. They edited transcripts, identified key themes and findings from the interviews with nurses conducted in the previous semester, and conducted new primary source research on Mary Washington Healthcare. The semester’s work culminated with Abigail, Grace, Ellen, and I presenting papers on the interviews with nurses and the project at a professional academic conference, the 2015 meeting of Oral History in the Mid-Atlantic Region (OHMAR).
Just before the end of the spring 2015 semester and a week after the OHMAR conference, Grace Mann was murdered. Her death is heartbreaking and tragic. She is and always will be missed by those who knew her. She was a compassionate, caring, smart, funny, thoughtful young woman whose life was far too short. I had the good fortune of serving as Grace’s advisor and having Grace in at least one of my classes in each of the three years she attended UMW. I am grateful we worked on this project together and for the opportunity to get to know her.
After graduating from UMW in 2015, Ellen Peiser served on this project as a freelance editor and did exceptional work with transcript editing.
For more information about the project, contact Jess Rigelhaupt, Principal Investigator: jess [at] rigelhaupt [dot] org.