Category Archives: RWJF Leaders
By Risa Lavizzo-Mourey, MD, MBA, President and CEO, Robert Wood Johnson Foundation
Change is a constant in health care. In the face of skyrocketing costs, system fragmentation, health disparities and an aging and sicker population, more care will be delivered in primary care and community/public health sites than in acute- and hospital-based settings. Yet we also face a primary care shortage and the coming infusion of 32 million newly insured people into the system.
To ensure an adequate supply of nurses with the advanced skills and expertise necessary to help bridge the gap while ensuring quality, higher levels of education are imperative. Thus, health care organizations, educational institutions and others are looking intently at the case for advancing nursing education as outlined in the Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health. Specifically, the IOM report recommended creating a system that produces more nurses educated at the Bachelor of Science (BSN) level and beyond.
Since its inception, the Robert Wood Johnson Foundation has understood the value of a strong, well-trained health care workforce. And we agree with the IOM report that the nursing profession has the potential to effect wide-reaching changes in the health care system. Further, we concur that an improved education system is necessary to ensure that nurses can continue to deliver safe, quality, patient-centered care required for the 21st century and beyond.
As I recently told NursingOutlookTalk.com, there are a number of things that hospitals and other organizations that employ nurses can do to facilitate education progression. And it is to their benefit to do so.
By Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey, MD, MBA
In March 1966, only two years before he would be assassinated, Martin Luther King Jr. uttered what I consider one of his most profound statements.
“Of all the forms of inequality,” he said, “injustice in health care is the most shocking and inhumane.”
The quotation is never far from my mind. It embodies so much of the work we do at the Foundation—to narrow and then eliminate disparities in health care access, to improve the health of all Americans. But especially every January, as the holiday to honor the civil rights leader again comes around, his words seem to resonate even more. And they mix once again with some very personal memories.
I met Dr. King once. I was 7 years old, and he was in Seattle for the first and last time in his life. After speaking to a big crowd downtown, he and a group of ministers and friends went out to dinner and then came to my house. My mother, a native of Atlanta, had known Martin from childhood. His father had married my parents and buried my grandparents. And now he sat in our living room, and I got to say hello. It was a scene, and a moment, you just don’t forget.
Nearly half a century later, I believe Dr. King would be both cautiously hopeful and deeply distressed over our nation’s health and health care. He would support the significant changes under way to improve access and quality in our health care system, but he would not minimize the significant inequities that endure between Whites and other racial and ethnic groups.
He would urge us all to work harder and push farther to bring about justice in health care. And so we shall.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Susan B. Hassmiller, PhD, RN, FAAN, RWJF senior adviser for nursing.
Since I am responsible for the Future of Nursing: Campaign for Action, my resolution would be to ensure that all of our State Action Coalitions get the help they need from us (the Robert Wood Johnson Foundation and AARP, our national partner) to implement whichever of the Institute of Medicine’s (IOM’s) report on the “Future of Nursing: Leading Change, Advancing Health” they believe makes most sense for their state.
I am humbled by the vast number of people who have come to work on this Campaign because they believe that doing so will make a difference and will indeed improve patient care in this country. And, in continuing to watch their work and supplement their needs, I am struck by the continued fragmentation of our system and vow to do what I can to foster collaboration on the part of health care providers. It really will make a difference for patients when there is true collaboration and teamwork.
Like the IOM report, I do believe that all providers must be able to practice to the top of their education and training and believe it makes the most sense in an era where cost and access issues are paramount. The level of care provided should be dictated by our needs as consumers. If there is a sound cost/benefit quotient based on evidence, that is what we should adhere to. Sometimes it is a family caregiver or a community health worker who will do the trick; sometimes a pharmacist; sometimes a nurse practitioner; and in the case of my mother who has had her life extended for which I am eternally grateful…it was a heart surgeon.
In this new year, this is what I am grateful for!
By Linda Wright Moore
RWJF Senior Communications Officer
Help wanted: Must be available and on call 24/7, year round. No vacations, no days off, no benefits or retirement plan. Base salary: zip. Likely to require taking time off from paid work (without pay) under the Family and Medical Leave Act. Qualified candidates should expect to use own funds, including savings, for expenses. Preferred applicants should have extensive experience in scheduling and arranging transportation to multiple appointments; administration of medications and treatments; and management of complex, chronic and acute conditions. Most importantly, they must be skilled at coordination of care, with capacity to connect with overburdened primary care providers who are too busy to talk, and a bloodhound’s nose for tracking down elusive specialists for consultation, on the rare days they are not in surgery at dawn, out to lunch or gone for the day at 3:45pm. Must agree to forgo taking care of one’s own health (no time for that!) Total commitment is required and will be rewarded with the satisfaction of doing the right thing for someone close to you – even as personal hopes, hobbies and aspirations are stashed in a lock box for which there is no key. WARNING: Rarely do individuals actively seek this position; like life itself, it generally just happens to people. And once it does, beware: you’re not allowed to quit.
If this sounds like your life – then you’re a family caregiver, and now is your time. Mine too. I’m the primary caregiver for my husband, who has been disabled for over a year now.
Here’s some good news: November is not just for turkey, dressing, Pilgrims and pumpkin pie. Along with Thanksgiving, November is National Family Caregivers Month, a time for recognizing and giving thanks for – and to – the 43.5 million family caregivers over age 18 in America, whose unpaid services to support the health needs of family members aged 50 or older were valued at $375 billion in 2007.
By Risa Lavizzo-Mourey, president and CEO, Robert Wood Johnson Foundation
Every year, the American Public Health Association (APHA) annual meeting features some of the best and brightest minds in health and health care. Taking place in Washington, D.C. from October 29 to November 2, it is a cutting edge event that advances critical research, helps shape policy and practice, and stimulates thinking on some of the most pressing health issues of our time. APHA notes that it is the oldest and largest gathering of public health professionals and, in my experience it is easily one of the most influential. I am very proud that, this year, it will feature dozens of Robert Wood Johnson Foundation (RWJF) scholars, fellows, alumni, grantees, staff and others who have been touched by Foundation programs.
Perhaps most exciting is that Melvin D. Shipp, OD, MPH, DrPH, a former RWJF Health Policy Fellow (1989-1990), is beginning his term as president of this prestigious organization. Shipp is dean of The Ohio State University College of Optometry and past president of the Association of Schools and Colleges of Optometry. He will hold the APHA leadership position for two years, and I know he will do great things during that time. At the meeting, Shipp will lead a session on the Health Policy Fellows program, explaining the experience and its impact on participants.
Among the many others from the RWJF “family” who will be featured at the annual meeting are:
By Najaf Ahmad, MPH, Communications Associate, Robert Wood Johnson Foundation Human Capital Portfolio
Walking through Barnes & Noble recently, a book on the “New Arrivals” rack stopped me in my tracks. By now you may know about My Sugar Obsession. So despite being in a rush, I was immediately drawn to Sugar Nation.
Imagine reuniting with a father you haven’t seen in years, finding him in an unrecognizable condition—a “human body in the process of cannibalizing itself”—on death’s door with a missing limb. Author Jeff O’Connell begins with this moving story of how he learned that his estranged father was slowly dying from the ravages of type 2 diabetes.
Despite having learned of his father’s leg amputation weeks earlier, O’Connell—former editor-in-chief at Muscle & Fitness magazine and executive writer at Men’s Health magazine—was certain he had nothing to worry about. He worked out, was lean and appeared healthy. His thin physique didn’t fit the stereotype of someone predisposed to developing type 2 diabetes.
A sobering visit with his doctor shook O’Connell to his core. He was diagnosed with pre-diabetes and headed down the same path as his father. Rather than accepting this fate though, he embarked on a mission to fight back against the enemy lurking within him. In doing so, he unearthed crucial information on how lifestyle factors influence diabetes.
More interestingly, he discovered the troubling manner in which health care providers are (or are not) responding to this burgeoning problem, going so far as to say that many “seem clueless when it comes to diagnosing this disease, let alone treating it.”
Although genes play a prominent role in predisposing someone to type 2 diabetes, lifestyle is a major influence. O’Connell underscores how type 2 diabetes stems from “the sum total of a very long trail of personal choices, made over a lifetime.” We pay a heavy price for our love affair with sugar, as massive quantities from processed foods shock our bodies. It shouldn’t be surprising then that one in three adults in the United States now has a blood sugar abnormality that predisposes them to diabetes-related complications such as heart disease, kidney failure and blindness. Sadly, many do not know they are affected until they develop these complications.
By Susan Hassmiller, PhD, RN, FAAN
RWJF Senior Adviser for Nursing and Director, Future of Nursing: Campaign for Action
Last summer, I took one of the most rewarding trips of my life: a European tour of key sites in the life of Florence Nightingale, the founder of modern nursing and one of the great leaders in improving health and health care worldwide.
So why is it that now, more than a century after Nightingale’s death, nurses are underrepresented in the rooms where we make decisions about how to improve the health care system? Very few of us hold executive-level positions in health care organizations, very few are voting members of health care boards of directors, and very few sit on the editorial boards of health care journals.
We can—and must—change this reality, and our nation’s opinion leaders agree. A 2009 survey conducted by Gallup on behalf of the Robert Wood Johnson Foundation (RWJF) found that an overwhelming majority of opinion leaders—including insurance, corporate, health services, government and industry thought leaders as well as university faculty—want nurses to have more influence in our health care system. The survey captured the feelings of more than 1,500 opinion leaders and was published in a recent edition of the Journal of Nursing Administration.
While opinion leaders said nurses don’t have enough influence over health reform, they did say that nurses have a great deal of influence over key elements of a quality health care system, such as reducing medical errors, improving safety, and improving the quality of patient care.
We nurses also have valuable insights to share. Nurses spend more time providing direct care to patients than other providers, work closely with caregivers and family members, and see patients in their broader social environments. As such, we have a unique understanding of the complex interplay of environment and health, and we have perspectives on health from a variety of settings: the hospital, the clinic, the community and the home.
In addition, nurses are highly valued by the public; nursing is consistently ranked among the most ethical and honest professions by the nation’s adults.
So how do we ensure that nurses’ voices are heard in the rooms where key decisions are made? One key way is to change the perception of nurses. Our Gallup survey found that nurses are not perceived as important decision-makers or revenue generators. When asked how much influence certain groups will have over health reform in the next five-to-10 years, opinion leaders ranked nurses seventh out of seven choices. Dead last.
In short, opinion leaders see us in our traditional—but limited role—as bedside clinicians, but not in more expansive and influential roles as health care leaders.
By Lori Melichar, Ph.D., M.A.
Senior Program Officer, Research and Evaluation, Robert Wood Johnson Foundation
I recently attended a National League for Nursing meeting of top nursing researchers, educators and leaders. Among the purposes of the meeting was to identify gaps in and opportunities to create knowledge to improve nursing education.
While meeting participants discussed several exciting efforts currently underway to improve nursing education, journal editors attending lamented the fact that most of the published research on nursing education innovations is based on single-site studies, making it unlikely to convince faculty to adopt new models of education or change core curriculum. The editors, educators and researchers agreed that research linking teaching methods and curricular content to patient outcomes would bolster efforts to transform patient care in the U.S. Evidence in this area is crucial because curricula are packed, faculty are overworked, change takes effort, and students don't always know what's best for them.
Producing more rigorous evidence is a strategy I often support as a member of the department of research and evaluation at the Robert Wood Johnson Foundation (RWJF). The Research Initiative component of the Campaign for Action, along with the Foundation's Evaluating Innovations in Nursing Education Program, will seek funding for studies of educational innovation over the next couple of years. It occurred to me that a strategy that might be more successful in the goal of quickly transforming nursing education falls out of the Foundation's flagship nursing program, Transforming Care at the Bedside (TCAB).
I was a part of the team from RWJF and the Institute for Healthcare Improvement (IHI) that developed the TCAB program that taught front-line nurses and their managers the skills and methods of continuous quality improvement, and inspired and empowered them to make changes to transform care at the bedside. The idea was that, though evidence should always be considered when it exists, there are things one can try to improve outcomes that matter, without first proving effectiveness.
By David Krol, M.D., M.P.H., F.A.A.P.
RWJF Human Capital Portfolio Team Director and Senior Program Officer
“Everyone has access to quality oral health care across the life cycle.”
That was the vision formed by a varied group of individuals from dentistry, dental hygiene, medicine, public health, nursing, economics, law, social work and philanthropy as they wrote the second of the Institute of Medicine’s reports on oral health, “Improving Access to Oral Health Care for Vulnerable and Underserved Populations.” I had the privilege of being a member of that committee. Our report was released on July 13th, 2011.
Our task was an expansive one. We were asked to:
- Assess the current U.S. oral health system of care;
- Explore its strengths, weaknesses and future challenges for the delivery of oral health care to vulnerable and underserved populations;
- Describe a desired vision for how oral health care for these populations should be addressed by public and private providers (including innovative programs) with a focus on safety net programs serving populations across the lifecycle and Maternal and Child Health Bureau programs serving vulnerable women and children; and
- Recommend strategies to achieve that vision.
Piece of cake right?!
Well, as you might guess, we found numerous, persistent and systemic barriers and challenges that vulnerable and underserved populations face in accessing oral health care. Those barriers include social, cultural, economic, structural, and geographic factors. We also recognized that these barriers contribute to profound and enduring oral health disparities in the United States. Americans who are poor, minority, or have special health care needs suffer disproportionately from dental disease and receive less care than the general population. It’s a sobering reality in that many of us take oral health care for granted or don’t even think about it at all until we are forced to.
By Linda Wright Moore
RWJF Senior Communications Officer
Attending the 36th annual convention of the National Association of Black Journalists (NABJ) last week in Philadelphia provided an opportunity to reflect on the many challenges facing reporters and the news industry in the 21st century. It was also a personal trip down my professional memory lane.
At the start of my career, as a television reporter and anchor, I attended my first NABJ annual meeting in New Orleans in 1983. The organization was small back then – just a few hundred members. We all knew each other by name. Fast forward to 2011, and I was happy to connect with old friends, including founders of the organization.
The group has grown dramatically to 3,000 members, and more than 2,500 people attended the Philadelphia gathering. The profession of journalism and newsgathering has also been transformed in response to tectonic shifts in the way we gather and disseminate information. Consider: “publisher” used to define an institution that had capacity to print a book, newspaper or magazine. Now, it’s anyone with a laptop, an Internet connection and something to say.
But don’t be fooled. The explosive growth of information and ease of access to it do not mean that journalism is a dying craft. In this 21st century age of information overload – where opinion, conjecture and even fiction can masquerade as fact – the ability to find credible, engaging, reliable sources of news and information is more valuable than ever. A free press is still the cornerstone of democracy – enabling us to make informed decisions about political leaders and policies. And we also rely on media to keep us informed about issues and policies affecting every aspect of our lives, including our health and health care.
At the Robert Wood Johnson Foundation (RWJF) booth at the NABJ Career Fair & Exhibition, we provided an array of information about Foundation programs – touching on the work of every team: Childhood Obesity, Coverage, Pioneer, Public Health, Quality/Equality, Vulnerable Populations and Human Capital. We distributed the first edition of the Human Capital Expert Resource Guide, which highlights the work and expertise of selected RWJF scholars, fellows and leaders with a focus on issues of concern to Black and Latino communities. We hope it will be a useful source of experts to interview for reporters developing stories around health and health care issues. Take a look and let us know how we can make future editions more useful for journalists and other researchers.