"I felt sure that if we built it, they would come," says Pat Wise, RRT, Director of Pulmonary Services at Memorial Hospital. As it is, building the ALA-I Lung Center has been less than half the battle. Staff estimate that the Lung Center has seen roughly fifty patients in the five months or so it’s been open.

Pat cites low physician referral as an ongoing issue that’s contributed to the ALA-I Lung Center’s small client rate. From the beginning, the ALA-I Lung Center was not a physician-driven program, and has had to work hard to improve physician understanding about what the Center can offer patients. "We were a little concerned that we’d be seen as a threat," says Pat. Currently, physician referrals are slowly increasing.

"The message we want to get to physicians is that we want to enhance your practice," says Stephanie McCune, the program’s marketer, "It’ll take a couple well-respected physicians in the community to feel good about us before the ice is truly broken in terms of referrals," she adds. In large part, Stephanie was hired in April to work on issues just like this one. She and Pat both have spent time contacting local organizations and making community visits to heighten awareness about the programs. Just recently they gained association with the Beds and Britches, Etc. program (see B.A.B.E. Learning History), another Memorial affiliated program that offers new parents coupons for baby merchandise and equipment. Parents receive the coupons only after they complete classes or activities designed to improve their own or their families’ health. The Lung Center can now dispense B.A.B.E. coupons as a part of that health incentive.

Still, some frustration is evident. "What the vision was initially is not what the realities are now," says Pat, "We’ll do almost anything we can to get to people -- go to churches, social groups...I don’t know how to make this any more successful...The lack of follow-through has been extremely disappointing."

Dick Beall defines the largest issue the ALA-I Lung Center faces very clearly: "It’s capturing people. The problem we’re having right now is in marketing...It’s like we’re having a party and no one comes except the respiratory therapist and the Lung Association staff, and we’re sitting there twiddling our thumbs and saying, ‘I wonder where the people are.’"

"There’s a lot of denial in chronic disease," Dick points out, a possible explanation for the low participant rate at the Center. Attending sessions with other lung disease sufferers may be too public for some people. Dick himself admits that he might attend a individual session, but probably not a group class, a large part of the Center’s programming. He points to a culture used to the idea of taking medication to alleviate problems. "We want to be able to take pills to feel good and then we don’t have to go to classes, park, get out, sit in a room with other people who are wheezing and say ‘I don’t know why I’m here.’"

Helping potential ALA-I Lung Center patients realize the connection between a higher quality of life and active participation in Center programs is the real hurdle. Dick says that many patients would invest a lot in alleviating their symptoms and getting more out of life. "We’ve got to find out now how to communicate to them that the Lung Center is a way to work toward becoming symptom free," he says.

Over the next several months, program staff and partners will assess the progress of the ALA-I Lung Center, an evaluation that may lead to changes, and possibly even discussions about the Center’s survival. He admits "there’s a sense of urgency to get this going," and Stephanie and Pat concur.

Stephanie, an energetic staff addition, moves back and forth from the American Lung

Association office to Memorial to the ALA-I Lung Center, which is located just minutes south of the hospital. An employee of the American Lung Association, she reports to Dick and Pat separately, and claims accountability to both institutions of the partnership. A challenge unique to her position has been acknowledging each partner’s agenda and finding common ground between them. One example of this struggle lies in the different background of collaborators, such as clinical, non-profit, and marketing fields. Stephanie makes a clear distinction between a clinical mind set, where people are often focused on simply "providing a service" and other settings where building community support, drawing people in, and promoting education and involvement are critical. "We all have to blend and mesh, but it just takes time," she says.

Stephanie’s job is linked to the success of the ALA-I Lung Center, and Pat admits that a certain feeling of risk underlies the project for everyone: "We all have something at stake here."

Nevertheless, the American Lung Association has begun to take the first steps in exploring the Lung Center concept in other Association regions as the first ALA-I Lung Center works to build a solid base of support. Dick cautions that hospital involvement is necessary for a program of this sort, and it is simple conversations between the Lung Association and hospitals that have begun in other areas.

These community partnerships could include more than one institution in an area. Pat Wise, RRT, Directory of Pulmonary Services at Memorial, says that from the beginning, the hospital worked to draw in partners, but that joint efforts were slow in coming together. Dick points to a lesson the Lung Association learned by saying, "I think if we were going to do it over again we might have sat down with the other hospitals here and explained to all of them at one time what it is we’re trying to do...I think we caused some hurt feelings...That may not be something Memorial is going to be experiencing, but as the Lung Association we have. And when that happens we have to be very open, honest, and straight-forward, by saying: ‘We just didn’t think. We hope you’ll forgive us.’ But we also have said that if this thing works we’re not going to be exclusive. Every hospital in the state of Indiana that wants a Lung Center ought to have a Lung Center..."

Dick also admits that the hospital partnership hasn’t worked quite as neatly as he imagined. "I thought that by working with the hospital we would have just tons of people flow through this thing [the Lung Center]. That hasn’t happened. I thought that there are doctors affiliated with Memorial. I thought ‘This is just going to be a natural.’ It still seems like it should be. I still can’t believe that it’s not."

Reg Wagle, Memorial Health Foundation Vice President, puts many of these challenges in perspective by emphasizing the value of the process. "Even if fails," he says, "we will have learned." Whether the end result is a Lung Center, or a better idea to address the issue, the direction remains true, though it may be marked by turns. Learning is a critical benefit of trying new things. "People are interested in experimentation in learning with the idea that they may be creating a new model," says Reg, "That’s the kind of wonderful risk-taking that we like to be a part of because we know how that excites people."