In academic medical centers promoting transformation toward integrative medicine and health, nurse leadership is rare. So is branding them with “spiritual” and “healing”. The usual chess game of change-making focuses on moving RCTs and systematic reviews like pawns to gain an advantage. Honoring the full professional value of licensed acupuncturists, chiropractors, naturopathic doctors and others is also rare. Most find it easier to gain the support of a dean by reducing such professionals to tools to deploy instead of as interprofessional partners. This year marks the 25th anniversary of an institution that modeled a road less traveled that included these and other distinctive, inclusive traits. The founder-director is nurse and health services researcher Mary Jo Kreitzer, RN, PhD, FAAN. I reached her for a long-overdue profile of a center that a close observer of the field has called “one of the most important centers globally for advancing integrative health.”

The entity is the Earl E. Bakken Center for Spirituality and Healing at the University of Minnesota. To prep for the article, I listened in on a September 18, 2020 public event that was part of the silver jubilee celebration. COVID dictated that it would need to go online. The folksiness I found in the Wellbeing Series for Planetary Health, Part 1 is likely part of the recipe for the Center’s esteemed place in the broader Minnesota community.

I didn’t know what to expect. What I – among the 1000 who signed up – found was one part pretty conventional: a core presentation on climate change. The keynote from author-scientist Katherine Wilkinson, PhD, founder of Project Drawdown, was, however, decidedly pro-activism. A sub-theme accented women leading climate activism. Surrounding this was an honoring of the indigenous peoples who were the original human dwellers of the real place from which the virtual event emanated. We heard songs from an indigenous teacher and local poet. A second featured presenter was a clearly beloved Minnesota musician, Craig Minowa, frontman for the alternative rock band Cloud Cult. Minowa posted up from an outdoor campfire from which he beamed in his ideas, and song.

The messages from the event were many. Be in the movement for health for the long haul. Don’t take your self too seriously. Engage! Enjoy song, and the arts. And if it is whole person health that interests you, keep your eye on the prizes, the big issues and determinants of health, like climate change. The messages are backed with action. Kreitzer shares that the University of Minnesota School of Nursing is the first in the nation to have, in Teddie Potter, PhD, RN, a position in planetary health.

Integrative uptake in specific departments

In its first years, Kreitzer already showed signs that her Center would march to a different drummer. Most academic medical integrative initiatives focused on the heroic task of somehow pulling the sword from the stone to create successful business models for integrative medicine clinics in economically and culturally hostile environments.

Kreitzer announced the opening of such a clinic, in collaboration with a local health system. When after a year the health system decided to suspend the operation,  she realized the Center’s spirituality and healing mission might bog down for years on a stagnant, dug-in and difficult front. She didn’t like the idea of the non-integrated integration of a stand-alone center. This would restrict investment in other initiatives that might prove more successful at galvanizing change toward healing-oriented models.

“I’m a champion of a very different approach,” explained Kreitzer. “Our work is not to make integrative health an extra department or facility but to build integrative services into other care.” She points to the integrative therapies program at the Pediatric Blood and Marrow Transplant Center, led by Megan Voss, RN, DNP. (Voss and Kreitzer co-authored this piece in the journal Children on the program.)

Another is presently in the Department of Psychiatry, led by Lidia Zylowska, MD, a psychiatrist and mind-body specialist who completed fellowship training in mindfulness and integrative medicine at the UCLA Center for East West Medicine. The typical integrative modalities utilized include therapies such as acupressure, guided imagery, mindfulness, breath-work, aromatherapy and massage.

Hers is a time-wizened view, to move where the river is running with one. She notes that the right combination of an integrative clinical leader and a receptive department are required. For instance, an integrative women’s health initiative that thrived for years under the leadership of Carolyn Torkelson, MD, MS has not been as visible since Torkelson’s recent retirement. It may yet flourish again with new leadership. And maybe not. Why push that river when other things are percolating?

Financial model

Kreitzer shared the Center’s annual report. The roughly $5.5-million of revenues shows a broad distribution of sources. She is clearly proud that, rather than a major reliance on philanthropy, “the largest source of revenues is from tuition.” These include Center courses that are either required or elective in over a half dozen academic units and degree tracks. “We’ve been very entrepreneurial,” Kreitzer shares: “Early on we were told that we can grow the Center, but we have to fund the growth.”

One can see the combination of both entrepreneurial and community service in their most recent Mindfulness Newsletter. A reader finds multiple avenues into the Center’s services. There are free seminars on mindful leadership, 4-week paid courses, programs on corporate well-being, participation in multi-week Mindfulness Based Stress Reduction programs, and weekly free “Stress Buster” online sessions. Who you gonna call?

The commitment to the community shines through again in the series of free Wellbeing Webinars that the Center is offering as part of the 25th anniversary celebration over this year.

The Center’s impact at 25 years

Some of the breadth of the Center’s impact is palpable in 21 short testimonials aggregated and posted as part of the 25th-year celebration. In one, a skilled website developer references the way the Center has built its Taking Charge of Your Health and Wellbeing public website to the point that it now has 2-million users across the globe. This is where, under an early R-25 education grant from what is now the National Center for Complementary and Integrative Health (NCCIH) the Center partnered with Northwestern Health Sciences University to create the respectful information, referenced in the opening paragraph, about the distinct integrative health professions.

Partnership is a theme: a content strategist with Caring Bridge – a powerful networking site for millions with cancer and other conditions – speaks to the collaboration the organization has been engaged since 2016 with this “absolute treasure” – the appellation the Caring Bridge leader hangs on the Center, and its founder:

One of the things about working with Dr. Kreitzer is that when people are talking about things and talking about possibilities, and she just says, quietly, ‘did you ever think about …’, or ‘that reminds me …’ or – it’s like having your own oracle. But I gotta tell you, how many oracles do you know who have been on stage with Dessa the rapper.

One begins in these testimonials to gain a sense of the transformative power in the Center’s academic programs. One is the pioneering health coaching work led by integrative, holistic physician Karen Lawson, MD. The program played an anchoring role in standard-setting in that field. The Doctor of Nursing Practice Program with a focus on “Integrative Health and Healing”, the development of which Kreitzer herself led, has caught the attention of a global community. Kreitzer has taken the message and model to multiple nations.

One of the testimonial voices is a savvy participant observer in the development of the academic integrative medicine movement, Georgetown’s Adi Haramati, PhD. In 2004, Kreitzer succeeded Haramati’s founding role at the Academic Consortium for Integrative Medicine and Health when she became its the second vice-chair.  His comments on the Center’s initiatives in research and in education conclude with this assessment:

Looking back, it is really amazing how your Center has helped shape the field. In the past few years, with the endowment from Earl Bakken and family, you are now poised to be one of the leading centers in the United States, if not in the world, in integrative health.

Kreitzer is a student of Otto Scharmer’s Theory U of “leading from the future”. His worked served as the framework for the needs assessment she and Voss wrote up on the integrative pediatrics model.  In Sharmer’s “model of transformational change,” they write, “there is a major focus on deeply listening to and understanding the needs of stakeholders in the organization.” She and Voss integrate this exploration into the central, values framework of the most progressive forces in the dominant school of medicine, the Quadruple Aim:

Integrative nursing has emerged as a framework for delivering sound patient care over the past five years. Principles closely aligned with the Institute for Healthcare Improvement’s (IHI) Quadruple Aim can be used to help clinicians work with their patients to achieve better outcomes at lower costs, while at the same time tending to clinician well-being [1]. In the current healthcare environment, clinicians are consistently asked to do more with less.

The integrative model is presented as a solution that can influence the whole set of aims. It’s not empty talk. The Center’s well-being guide, Wellbeing 101:Tips and Strategies to Help You Focus on Wellbeing, has been distributed widely across all U of MN Campus communities throughout Minnesota. A version for the general public is also available. (See the end of this article.)

Research

Amidst it all, Kreitzer has maintained a robust research career. She has held entrepreneurial roles in editorial leadership with Global Advances in Health and Medicine and at JACM-Paradigm, Practice and Policy Advancing Integrative Health (The Journal of Alternative and Complementary Medicine). Her ResearchGate page gives her a remarkable 36.61 rating – given all of her other responsibilities – based on 2445 citations on 169 publications.

The Center’s research team had a coup just over 5 years ago when two of the nation’s top chiropractor researchers, Gert Bronfort, DC, PhD and Roni Evans, DC, MS, PhD, moved across greater Minneapolis from Northwestern Health Sciences University to join the Center. They since secured a $14-million multi-center integrative pain grant. from the NIH National Center for Complementary and Integrative Health.

During the course of writing this article, Kreitzer sent me a media notice of her most recent scientific publication. She served as anchor author. This was a biomedical engineering paper in which they found that individuals “with just eight lessons in mindfulness-based attention and training demonstrated significant advantages compared to those with no prior meditation training, in their initial ability to control brain activity during rest.”

George Floyd, race, and equity

That the Center is located in the city in which George Floyd was murdered led me to query about how the Center has responded. Notably, most of what Kreitzer shared related to how, with their long focus on community well-being and public health, equity and race are already built into their mission.

I reviewed a 2018 talk she gave that “was edgy in some ways” then. She had included social justice and racial inequity into her concept of well-being. What Kreitzer was discussing then is front and center today. Also prior to the murder, the Center had booked talks from Rhonda McGee and Celeste Headlee for their well-being lecture series.  Each of their work focuses on racial justice. In addition, The Taking Charge of Your Health site includes content on mindfulness and racial justice, and the importance of inclusivity in well-being.

I shared with Kreitzer my awareness that each of the Center people I have noted here are white. She responded directly: “The Center has attracted a diverse student base and has been highly successful in attracting diverse populations to research studies. It has not fully achieved the Center’s diversity goals in the composition of faculty and staff.”

Closing comments

This article has been a long-time coming. I’ve known of Kreitzer’s work through periodic reporting on activities there. More important to me personally have been a series of professional intersections with Kreitzer over this quarter century. I share these as they add to the magnitude of her influence – especially if you allow yourself to multiply these actions times those with scores of other individuals with whom she has collaborated over the years, and that are not referenced above.

• She was a strong Consortium supporter of the interprofessional 2005 National Education Dialogue (NED) to Advance Integrated Care: Creating Common Ground, for which I served in leadership. At the time, the Consortium as an organization was not yet confident enough to openly partner with the likes of chiropractors and naturopathic doctors. (Notably, through Michael Traub, ND, Earl Bakken became the second most significant philanthropic partner for NED.)
• Kreitzer became a member of the Board of Advisers to an offshoot of NED, the Academic Collaborative for Integrative Health (ACIH), when some of us were creating an organization to forge stronger relationships between the licensed “CAM” fields and the dominant school of medicine.
• When she co-edited, Global Advances, she supported a suggestion from Michele Mittelman that I regularly become a columnist in that peer-reviewed journal.
• With the support of ACIH colleagues, Kreitzer was placed into key roles at two National Academy of Medicine workshops. One focused on interprofessional care. The second, which she co-chaired, explored A Design Thinking, Systems Approach to Wellbeing within Education and Practice.
• Again, personally, when I was most insecure 4 years ago in a new position as editor-in-chief of JACM-Paradigm, Practice and Policy Advancing Integrative Health (The Journal of Alternative and Complementary Medicine), Kreitzer blessed my move and pulled energy to the journal by coming aboard as an Executive Editor.

Most in the integrative space share a desire for a systemic change of the reductive, production-oriented medical industry toward a system that focuses on health and well-being. The first encounter zone – efforts to integrate and transform clinical services – has for many increasingly broadened to embrace the need to influence the more pervasive social determinants of health. Kreitzer was early on this path. The Center’s circles of ever expanding impact underscore the value of keeping one’s eye on the prize.

Note: The booklet below accidentally loaded when I meant only to bring a link to this page. My technical skills did not allow me to remove it. It is apparently meant to be here. Enjoy this resource for the Center!

Click to access umncsh_wellbeing_guide_adults_fall2020.pdf