Category Archives: Health Care Quality
Lisa Cooper, MD, MPH, FACP, is the James F. Fries Professor of Medicine at Johns Hopkins University School of Medicine, Director of the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, and an alumna of the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program.
Have you ever had the experience of being sick and in need of help from a health professional? How about having a parent, child, other family member, or friend who had some health issue for which he or she was seeking answers? What was that like for you? How did you feel, and what were you looking for from that doctor, nurse, or therapist?
Did you ever feel afraid, and alone? Confused? That no one understood what you were going through? Or cared? Or even worse, that the health professionals may have made some assumptions about you or your family member that were wrong – even perhaps blamed you for having your condition or judged you for how you were dealing with it?
If so, you are not alone. Many people who find themselves in the role of a patient have felt these same feelings and had these same thoughts. And if you are poor, don’t have private health insurance, or if you are a person of color or belong to another minority group in our country, you are more likely than others to encounter these problems.
Cynda Rushton, PhD, RN, FAAN, is the Anne and George L. Bunting Professor of Clinical Ethics and a professor of nursing and pediatrics at Johns Hopkins University. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2006-2009). In 2014, she was named a Hastings Center Fellow for her work in bioethics.
Human Capital Blog: Congratulations on being named a 2014 Hastings Center Fellow. What does this fellowship mean for you and your career?
Cynda Rushton: It’s a wonderful honor to be included in this interprofessional group of scholars of bioethics. It’s a terrific opportunity to cross-pollinate with great thinkers and leaders and to think about some of the most vexing ethical issues in health care. It’s going to be a rich container for dialogue, learning, and leadership.
HCB: How will the fellowship work?
Rushton: Fellows have the opportunity to help guide the direction of the Hastings Center, which is an independent, non-partisan and nonprofit bioethics research institute in New York. The center’s mission is to address fundamental ethical issues in the areas of health, medicine, and the environment, and we’ll be bringing up issues that we think deserve more in-depth scholarship and research. This summer, we’re having a retreat where we will be able to work together around issues of common concern, particularly in the area of bioethics.
HCB: What will you focus on as a fellow?
Rushton: My focus has been on how to create a culture of ethical practice in health care. I’m interested in what is required to create that culture and what kind of individual competencies need to be in place to support people to practice ethically and reduce moral distress.
Understanding Microcultures of Health: It’s Time for a ‘Deep Dive’ into Culture & Social Networks to Produce Lasting Health Change
Jason M. Fletcher, PhD, is associate professor at the La Follette School of Public Affairs, Department of Sociology, Department of Agricultural and Applied Economics, and Department of Population Health Sciences at the University of Wisconsin-Madison. He is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program at Columbia University, where he researched the intersection of health and social networks.
While an important priority for improving health and health care in the United States is in focusing on broad notions, such as creating a Culture of Health, there is also a need to consider targeted approaches that make use of the structure of relationships that influence health. Most people consider only a small number of social contacts when discussing important matters. Even though our Facebook friends number in the hundreds or thousands, the number with whom we share close and regular geographic or social space is considerably smaller. Network science is leading the way in uncovering what our microcultures look like and how they operate; these findings should be put to further use to improve population health.
These “small worlds” of influence are known to have substantial impacts on health—as shown by numerous careful, gold-standard empirical studies. College freshman who are randomly assigned a roommate who binge drinks are more likely to binge drink, themselves. Adults whose spouses stop smoking through a clinical intervention are themselves much more likely to stop smoking. These positive and negative impacts on health spread not through broad culture but through the “microcultures” of close social ties.
Felesia Bowen, PhD, PCPNP-BC, is an assistant professor at Rutgers University School of Nursing, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2014-2017). Her research focuses on community-based pediatric asthma care.
When I first began working as a pediatric nurse in New Jersey 20 years ago, I was committed to getting asthma care right. I worked hard to educate my young patients and their families about the disease, how to avoid the triggers that cause attacks, and how to use their medications. I wrote asthma action plans and prescribed the correct medications to control symptoms.
It wasn’t always enough. One Monday morning, one of my young patients experienced asthma symptoms. The family followed his asthma action plan, “stepping” his medications in an effort to relieve his asthma symptoms. On Tuesday, he wasn’t feeling better, and went to the nurse practitioner (NP) in his school’s health office, who appropriately modified his treatment plan and called the asthma specialist to get a next-day appointment for him.
She remembers the young man telling her that he really needed to feel better, because he was going to his middle school graduation dance Wednesday night. On Thursday morning, he visited the NP again, still with asthma symptoms. He told her that he had missed the appointment with the asthma specialist because his mom couldn’t make it—she had health issues of her own, and three other children to care for. But he’d gone to his dance and proudly showed her his middle school class ring.
Brian D. Smedley, PhD, is executive director of the National Collaborative for Health Equity in Washington, D.C.
Relative to national averages, many people of color have poorer health from the cradle to the grave—beginning at birth, with higher rates of low birth weight and infant mortality; through childhood and adolescence, with higher rates of asthma and unhealthy weight; into adulthood, with higher rates of chronic disease and disability; and at the end of life, with higher rates of premature death and shortened lifespans.
Public health research shows that these health inequities are mostly attributable to factors beyond health care access and quality: As a result of residential segregation, people of color are more likely than whites to live in neighborhoods with a high concentration of health risks, and a relative paucity of health-enhancing resources. Highly-segregated communities of color are too often overrun with environmental health threats brought about by polluting industries, and vendors selling unhealthy products such as tobacco, alcohol, and high-fat, high-sugar, and/or high-sodium products. At the same time, many of these same communities lack access to affordable, nutritious food; safe spaces for exercise, recreation, and play; and high-quality schools that prepare children well for the high levels of education that are often protective of health.
Pooja Mehta, MD, is a generalist obstetrician/gynecologist and a second-year Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, with support from the Department of Veterans Affairs. Rebekah Gee, MD, MHS, is Medicaid Medical Director for the state of Louisiana, an assistant professor of health policy and management, and obstetrics and gynecology at Louisiana State University and an alumna of the RWJF Clinical Scholars program.*
The theory of disruptive innovation seeks to explain how complicated, expensive systems may eventually be replaced by simpler, more affordable solutions, driven by new entrants into a market who “disrupt” an older, less efficient, and less accessible order.
In the new issue of Current Opinion in Obstetrics and Gynecology, we track the history of the RWJF Clinical Scholars program (CSP) in the field of obstetrics and gynecology, and offer a curated selection of pieces that suggest that our discipline—now peppered with experts in health services research and health policy trained through the CSP—could be teetering at the precipice of an era of such disruptive innovation.
Highlighting the work of nine current and past scholars, among more than 40 Clinical Scholars working in the field of obstetrics and gynecology, this journal issue covers a range of cutting-edge concepts currently being developed and employed to transform our field from the inside out.
Nathaniel DeNicola, MD, (‘11) discusses the potential uses of social media to disseminate and advance new findings and recommendations to broader audiences. Laurie Zephyrin, MD, MBA, (’03) illuminates how efforts to integrate systems, create interdisciplinary initiatives, and how research-clinical partnerships have allowed for rapid organizational and cultural change and have advanced reproductive health care in the Veterans Affairs system.
Elizabeth Krans, MD, (‘09) writes about ways in which new public funding is allowing for disruptive innovation in the delivery of prenatal care—for example, through dissemination of the highly decentralized, patient-driven Centering Pregnancy model. Working from within a city health department, Erin Saleeby, MD, (‘10) writes about how participatory approaches to public health governance can engage community and clinician leaders in the process of redesigning reproductive care and transforming outcomes.
For the 25th anniversary of the Robert Wood Johnson Foundation’s (RWJF) Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Juan Jose Ferreris, MD, a member of the Class of 1989.
‘It is easier to build strong children than to repair broken men.’
The words of abolitionist Frederick Douglass resonate for Juan Jose Ferreris, a pediatrician and assistant clinical adjunct professor at University of Texas Health Science Center. He sees a straight line between the public funds allocated for children’s care and their well-being as adults.
“Kids receive less than 20 cents of every health care dollar. Meanwhile, 80 percent goes to adult end-of-life care. Why aren’t we spending those funds on people when they’re young, when it could make a genuine difference?”
Ferreris contends that money also shapes health in less obvious ways. Salaries of primary care physicians are well below those of more “glamorous” specialists. Some fledgling MDs, burdened with medical school debt, reason that they can’t afford not to specialize. Consequently, he says, only 3 percent of medical students choose primary care.
For Ferreris, who is both humbled and inspired by his young patients, building a Culture of Health necessitates recalibrating priorities.
“Nobody’s concentrating on the whole; they’re only looking at one part. And they’re not paying attention to the human—the brain, the spirit, the soul.
“We overlook that aspect...but it’s where I believe the primary care doctor has irreplaceable value.”
Ed Wagner, MD, MPH, is director emeritus of the MacColl Center for Health Care Innovation. A general internist and epidemiologist, Wagner was founding director of Group Health Research Institute.
Better care. Healthier patients. Happier staff. A new online resource provides practical, hands-on tools to build better primary care teams that can put those outcomes within reach.
Nationwide, primary care practices are finding that creating more effective practice teams is the key to becoming a patient-centered medical home, improving patients’ health, and increasing productivity. The Improving Primary Care Team Guide (Team Guide) is a free online resource for primary care practices working to do just that. It:
- Provides hands-on tools and resources that are actionable and measureable
- Is appropriate for practices at any stage of development
- Includes modules that enable practices to easily pinpoint relevant topics and areas of interest
The new Team Guide presents practical advice, case studies, and tools from 31 exemplary primary care practices across the country that have markedly improved care, efficiency, and job satisfaction by transforming to a team-based approach. For the last three years, with funding from the Robert Wood Johnson Foundation (RWJF), the LEAP team has identified, studied, and engaged these practices to develop the lessons contained in the Team Guide.
Minoo Sarkarati, BA, is a third-year medical student and Robert Wood Johnson Foundation (RWJF) Health Policy Scholar at Meharry Medical College. She completed her undergraduate degrees of psychology and integrative biology at the University of California, Berkeley. Learn about the RWJF Briefings @ the Booth at the APHA Annual Meeting on Monday, November 17 and Tuesday, November 18.
What determines your health? Is it your ZIP code? Is it the clinic or hospital you go to? Is it the physician you see? Or is it you?
I could not say that the answer to this critical question is solely any one of these. However, understanding how each component plays a role in one’s health, as well as exploring further determinants, is vital to building healthier communities.
This year’s American Public Health Association (APHA) Meeting theme is Healthography. It is an opportunity to explore how our environment—whether it is access to clean air, safe housing, transportation, healthy foods, safe places to exercise, jobs, or quality health care—plays a role in our health.
As a medical student training in a safety-net hospital, I have seen how each of these elements plays a role in one’s health. Without addressing these factors, a large part of medical care is lost. Encouraging regular exercise is not so simple when you do not have sidewalks or green spaces, or you do not feel safe being outside in your neighborhood. Writing a prescription to treat diabetes becomes meaningless if your patient cannot fill it because he/she does not make enough income to purchase the medication.
Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, are co-principal investigators of a study, supported by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative, that generated evidence linking nurse staffing and work environments to infant outcomes in a national sample of neonatal intensive care units.* A new documentary, “Surviving Year One,” examines infant mortality in Rochester, N.Y. and nationwide. It is being shown on PBS and World Channel stations (check local listings). Read more about it on the RWJF Culture of Health Blog here and here.
Are some premature babies simply born in the wrong place? Premature babies are fragile at birth and most infant deaths in this country are due to prematurity. It is well established that blacks have poorer health than whites in our country, but the origin of these disparities is still a mystery. It’s possible that the hospital in which a child is born may tell us why certain population groups have poorer health.
A new study by University of Pennsylvania and Rutgers investigators that I led shows that seven out of ten black infants with very low birth weights (less than 3.2 lbs.) in the United States have the simple misfortune of being born in inferior hospitals. What makes these hospitals inferior? A big component is lower nurse staffing ratios and work environments that are less supportive of excellent nursing practice than other hospitals. Our study, which was funded by the RWJF Interdisciplinary Nursing Quality Research Initiative, indicates that the hospitals in which infants are born can affect their health all their lives.
A Brighter Future
What can be done to make these hospitals better? A first step would be to include nurses in decisions at all levels of the hospital, as recommended by the Institute of Medicine to position nursing to lead change and advance health. Laws in seven states require hospitals to have staff nurses participate in developing plans for safe staffing levels on all units.