Bridging Policy and Practice to Solve Health Care Problems

    • May 15, 2014

As a Robert Wood Johnson Foundation Health Policy Fellow in 2007 and 2008, Deborah Trautman, PhD, had a front-line role in helping to shape and promote the legislation that would become the Affordable Care Act (ACA). Today, she is bringing together policy makers, researchers, and health care professionals to figure out how to implement the law as executive director of Johns Hopkins’ Center for Health Policy and Healthcare Transformation. On June 16, 2014, Trautman becomes CEO of the American Association of Colleges of Nursing where she will continue to increase nursing's visibility, participation, and leadership in national efforts to improve health and health care.

A natural progression. For Trautman, becoming a Health Policy Fellow was a natural step along her journey within the nursing profession. She was originally drawn to health care because she liked to interact with people and “make a meaningful difference.” After earning an undergraduate nursing degree at West Virginia Wesleyan College, she worked as a clinical nurse at Presbyterian University Hospital, not far from the western Pennsylvania town where she grew up. But when she began studying for a master’s degree in nursing education and administration at the University of Pittsburgh, Trautman found she also had a talent and passion for solving bigger, more systemic issues.

A part-time job as weekend supervisor at the hospital put Trautman in a leadership role, scheduling staff and trouble-shooting crises. “I loved it!” Trautman recalls. “My very first call as an administrator was for a problem with a trash compactor. I had no idea what to do. But I learned it was about problem-solving—being able to assess the situation and think through, with others, what the right course of action was and who had the right resources to address the problem.”

Trautman continued her education, earning a PhD in health policy from the University of Maryland. She honed her policy skills as she climbed the administrative ladder, becoming director of nursing for emergency medicine at the Johns Hopkins Hospital in Baltimore and then vice president of patient care for a county hospital in the Johns Hopkins Health System.

Learning about the federal health policy world. It was the stint as an RWJF Health Policy Fellow that gave Trautman a chance to see what it really means to shape large-scale strategies for solving health care problems.

The Robert Wood Johnson Foundation Health Policy Fellows program gives exceptional midcareer health, behavioral, and social science professionals an opportunity to increase their understanding of federal health policy. Fellows participate in the federal policy process and use that leadership experience to improve health, health care, and health policy. Read the Program Results Report to learn more about the program.

Stationed in Speaker of the House Rep. Nancy Pelosi’s office at the time the guiding principles for national health care reform were under development, Trautman worked directly with Wendell Primus, Pelosi’s senior policy advisor on health and the budget.

Gaining firsthand experience. Trautman’s responsibilities included tracking House committee actions related to health policy, from the earliest discussions about issues to the passage of legislation. She also helped identify and resolve potential conflicts between competing interests—as countless panels were convened to discuss health care reform—and she helped people understand the proposed reforms.

When one member of Congress argued that a provision Pelosi’s office supported “wasn’t strong enough around personal responsibility,” for example, Trautman brought into the conversation the science needed to counteract the proposed change. And when the Speaker’s office released a draft of the ACA to members of Congress, it deployed Trautman to make sure people understood the nuances.

From these experiences, she acquired invaluable knowledge about how to move public policy.

“It really is important to bring evidence to bear on what you are trying to fix and why the solution you are proposing is the best one. It is about evidence, relationships, and communication,” Trautman says.

She also learned to focus on outcomes, have a clear vision, and be able to interact well with the people who help carry out the vision—and to think strategically about how to foster collaboration among diverse interests.

“I’ve learned you can move forward further if you go together,” Trautman observes. “It is really true that you might be able to go faster alone, but you can go further if you have more individuals working with you toward the same goal.”

Applying public policy skills in the private sector. Today, Trautman finds her work as executive director of Johns Hopkins’ Center for Health Policy and Healthcare Transformation just as exciting. In addition to health care reform, the center focuses on research and discovery; quality and safety; payment reform; population health; innovation; workforce issues ; patient, clinician, and community engagement; the unintended consequences of health policy and regulation; and comparative effectiveness.

For example, the center hosts an annual, two-day meeting for state legislators on topics such as the state health exchanges required by the ACA and other challenges looming on the health care horizon.

Center staff members confer with government leaders to stay on top of upcoming policy developments, and help staff in institutions within Johns Hopkins understand how to implement the ACA. This includes preparing materials explaining the practical implications of health policy and the resources available to patients.

Trautman looks for ways to strengthen understanding of health policy issues within Hopkins’ health professions schools. And she teaches a course on health policy leadership, in which she emphasizes the importance of being informed about health policy and tries to pass on the qualities she valued in her own mentors: high standards, respect for individuals, honesty, transparency, and the ability to inspire people to do their best.

In all of these activities, Trautman applies knowledge she gained through her fellowship. “Health policy is about decision-making,” she says: “What [choice is] going to help us realize the goal of better health and health care? What are we doing or could we be doing to move forward? What are the lessons learned from our experiences with patients in our care and from being in an accountable care organization? What are the needs of the workforce of today versus what they need to be tomorrow?”

Trautman remains committed to the collaborative approach that Primus used to rally bipartisan support in the House for health care reform. Lining up a broad array of supporters, not just within one institution but across communities of practice, “will yield something more robust than we could have gotten with just one group alone,” she says. Above all, perhaps, Trautman left her fellowship better able to consider health policy in a broad context.

Looking ahead. Trautman notes that while much progress has been made in health policy, much more remains to be done. Consensus has grown nationally that a health care problem exists, but not about how to solve it.

Important opportunities for health policy include: shortening the amount of time needed to move knowledge from research into practice, making sure that nurses participate in redesigning health care, and balancing the needs of patients and regulators as providers move to a patient-centered model of care.

More than ever, Trautman believes, it is crucial to participate in policy change—to “be informed and to think strategically about who will benefit from information and how to get the information to them.”

Recalling a phrase popular among congressional staff—Don’t let perfect be the enemy of good—she notes that when it comes to health care policy, “The journey does not have an endpoint, just a continuous need to move forward.”

RWJF Perspective. “The RWJF Health Policy Fellows program is a flagship program for the foundation and one important way we seek to improve the health and health care of all Americans,” says Michael Painter, JD, MD, senior program officer and former RWJF Health Policy Fellow (2003–2004).

“It is critically important that health care professionals—physicians, nurses, behavioral scientists, and others—realize that they can and must play important roles in promoting impactful, positive, informed change. The program provides a great way to help them learn how to do that and to learn firsthand the important relationship between politics and policy.

“I absolutely could not do what I'm doing today without that experience,” Painter adds.