Some health care riddles can be solved by treating the system rather than the individual.
Take the case of thrush, a bacterial infection often transmitted between breastfed infants and their mothers. Pediatricians treat the baby but not the mother, while lactation consultants and doctors treat the mother but not the baby. But unless both are treated together (the disease passes from the baby’s mouth to the mother’s nipple and back again) the infection will often persist.
One answer to the problem? Restructure health care systems to foster interprofessional collaboration so mothers and babies can be treated together rather than apart.
The practice is on vivid display at new outpatient breastfeeding clinics at Genesys Regional Medical Center in Michigan. There, a doctor and lactation consultant nurses work together in a unique partnership to treat mothers and their babies at the same time. The breastfeeding clinics are a collaboration among Michigan-based Ascension hospitals and the first in the state to be led by physicians. They treat a wide range of problems from thrush to mastitis to cleft palate.
The doctor-nurse collaborative is a new initiative, but the benefits to patients are already evident, according to the center’s pediatric medical director, Sara Pendleton, M.D., an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholar (1996-1998) program. The lactation consultants bring expertise in technique and support for breastfeeding moms while the physician treats medical issues for both mother and baby. “It’s one-stop shopping to provide holistic care for our patients,” Pendleton says.
The partnership makes financial sense as well. Physician services for breastfeeding problems increase revenues for the center, which help it weather financial challenges in a region marked by high rates of poverty and joblessness resulting from the decline of the auto industry.
The clinics are just one manifestation of a new emphasis at the center on interprofessional collaboration, according to the center’s Interim Vice President of Nursing, Charlotte Mather, M.B.A., R.N., an alumnus (2008-2011) of the RWJF Executive Nurse Fellows program. Together, Mather and Pendleton are working to enhance interprofessional collaboration to improve the quality of care, safety, and patient satisfaction rates.
“We are encouraging our providers to work together as one machine, instead of one person writing orders and another person following them,” Mather said. “Everybody’s input is important and needs to be assessed objectively. The patient benefits from that.”
As RWJF Alumni, Mather and Pendleton Share Similar Views about Teamwork
Mather, a nurse and administrator, and Pendleton, a physician and researcher, can speak firsthand to the value of interprofessional partnerships.
Their story began last year, when Pendleton returned to her home town in central Michigan to care for ill family members. She “cold called” Genesys Regional Medical Center, and wound up speaking to Mather, who was searching for a doctor to transform the center’s pediatric care program. When Mather heard that Pendleton was also an alumnus of a program supported by the Foundation, she had “an instant affinity” for her.
“I knew she would be much more open to innovation and networking because of her experience as a Clinical Scholar…and that she would know what it meant to work as part of an interprofessional team,” Mather said. “We have similar backgrounds and share a similar philosophy even though we have different professional perspectives.”
Indeed, as alumni of programs supported by the Foundation, Mather and Pendleton are well versed in the value of interprofessional collaboration. This spring, Mather completed the RJWF Executive Nurse Fellows program, a three-year advanced leadership program for nurses who aspire to lead and shape health care locally and nationally. Team-based learning and implementation of team projects are central elements of the program.
Teamwork is also an emphasis of the Clinical Scholars program, which fosters the development of physicians who are leading the transformation of health care in this country through positions in academic medicine, public health, and other leadership roles.
The Foundation has also recently launched a massive, multifaceted campaign to improve health by transforming the nursing profession. It is based upon a groundbreaking report released last year by the Institute of Medicine (IOM). One fundamental way to transform nursing, according to the report—called The Future of Nursing: Leading Change, Advancing Health—is to foster teamwork among all health professionals at all levels.
“As leaders, nurses must act as full partners in redesign efforts, be accountable for their own contributions to delivering high-quality care, and work collaboratively with leaders from other health professions,” the IOM report states.
Mather and Pendleton—both health professionals, both RWJF alumni, both Michigan natives and both working mothers of four children—embody that kind of collaboration.
“We do everything together,” Mather said during a joint interview. Pendleton chimed in: “We both assess the impact of a program on the patient from different perspectives. It’s not an adversarial relationship; we both gain valuable insights from each other.”
Mather hired Pendleton last May, and together they’ve conducted a strategic assessment of the pediatric department; negotiated proposed changes with representatives from other departments; trained health providers from other departments in pediatric care; and implemented evidence-based order sets to decrease variability and increase utilization of “best practices” data.
The new program—modeled on a pediatric hospitalist system with innovative components to fit the specific needs of the community—will officially launch in September.
Meanwhile, Mather and Pendleton are forging stronger partnerships with other providers in their organization and in the community to improve asthma education and safety procedures. The key to success, Mather says, is the kind of interprofessional collaboration she and Pendleton enjoy.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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