Col­lab­o­ra­tion counts

Greater team­work among clin­i­cians, foun­da­tions to im­prove nurs­ing pro­fes­sion

Modern Healthcare - - OPINIONS COMMENTARY - Dr. Risa Lav­izzo-mourey

As the leader of a phi­lan­thropy whose founder rec­og­nized early on the value of nurses to his own med­i­cal care and to health­care writ large, I wel­comed last year’s In­sti­tute of Medicine re­port, The Fu­ture of Nurs­ing: Lead­ing Change, Ad­vanc­ing Health, with great ex­pec­ta­tion. In the com­ing years, our na­tion’s health­care sys­tem will serve 32 mil­lion newly in­sured Amer­i­cans as well as rapidly in­creas­ing numbers of se­niors and peo­ple with chronic con­di­tions. And it will do so in the con­text of chang­ing mod­els and set­tings for care de­liv­ery.

Our foun­da­tion has long be­lieved that a highly ca­pa­ble nurs­ing work­force is crit­i­cal to pro­vid­ing ac­ces­si­ble, qual­ity care. To meet the health­care needs of all Amer­i­cans, we must strengthen the nurs­ing pro­fes­sion at all lev­els, from the front lines to the ex­ec­u­tive ranks. That is pre­cisely why we part­nered with the in­sti­tute on this re­port, which quickly joined other in­sti­tute stud­ies on the qual­ity of care, med­i­cal er­rors and pub­lic health as a land­mark doc­u­ment.

We knew when The Fu­ture of Nurs­ing was re­leased that it held im­mense po­ten­tial to il­lu­mi­nate the ways in which nurses could help to ad­dress the health­care chal­lenges we con­front. It con­cluded that the full ca­pac­ity of the nurs­ing work­force had to be tapped. To ef­fect that, it rec­om­mended changes within nurs­ing ed­u­ca­tion, scope of prac­tice, in­ter­pro­fes­sional col­lab­o­ra­tion and lead­er­ship.

A year later, we are wit­ness­ing the re­port’s im­pact through ini­tia­tives across the coun­try. Yet truly re­al­iz­ing the re­port’s prom­ise—for nurs­ing, for the health­care sys­tem and for pa­tients—will re­quire sus­tained ac­tion. I am talk­ing about new, even vi­sion­ary ways of ed­u­cat­ing, train­ing and utiliz­ing nurses and other providers that put pa­tients front and cen­ter.

This will de­mand a national, col­lab­o­ra­tive move­ment, and it will not come about un­less stake­hold­ers and lead­ers to­gether com­mit to trans­form­ing health­care as we know it into health­care as we know it can and should be. Col­lab­o­ra­tion will in­deed be a linch­pin— across pro­fes­sions and sec­tors—as will recog­ni­tion of nurses’ roles as part­ners and lead­ers in the con­tin­u­ing push for im­prove­ment.

In­ter­pro­fes­sional di­a­logue and work al­ready is tak­ing place through the Fu­ture of Nurs­ing: Cam­paign for Ac­tion. The cam­paign is co­or­di­nated by the Cen­ter to Cham­pion Nurs­ing in Amer­ica, an ini­tia­tive of AARP, the AARP Foun­da­tion and the Robert Wood John­son Foun­da­tion. It has helped unite nurs­ing and other health pro­fes­sions’ lead­ers, even as broad-based groups have co­a­lesced in nearly ev­ery state to push ahead.

Na­tion­ally, more than 70 or­ga­ni­za­tions are work­ing through the cen­ter to craft strate­gies to carry out the re­port’s rec­om­men­da­tions. There also are now 36 cam­paign-des­ig­nated state ac­tion coali­tions, made up of nurses and other health­care pro­fes­sion­als, busi­ness lead­ers, con­sumers and oth­ers, that have con­vened to im­ple­ment the re­port’s rec­om­men­da­tions in the most promis­ing ways in their states.

In re­sponse to the spe­cific rec­om­men­da­tion that pri­vate and pub­lic fun­ders should col­lab­o­rate to ad­vance re­search on mod­els of care and in­no­va­tive so­lu­tions, the Robert Wood John­son Foun­da­tion has joined with other ma­jor phi­lan­thropies to form a com­mu­nity of fun­ders. This ven­ture ( the­fu­ture­ofnurs­ing. org/ re­search) will fo­cus national at­ten­tion on a com­mon re­search agenda re­lated to the re­port rec- om­men­da­tions, from in­ter­pro­fes­sional ed­u­ca­tion and nurs­ing res­i­dency pro­grams to the dif­fu­sion of ef­fec­tive prac­tices across health­care set­tings and mod­els.

There is grow­ing ev­i­dence that col­lab­o­ra­tion con­trib­utes to im­prov­ing the qual­ity of care. For ex­am­ple, to pro­vide the best pos­si­ble care to the med­i­cally vul­ner­a­ble chil­dren it serves, Chil­dren’s Med­i­cal Ser­vices of South­east Florida ap­proaches each case through teams that in­te­grate the work of physi­cians, nurses, so­cial work­ers and oth­ers. In ad­di­tion to bring­ing clin­i­cal ex­per­tise, the nurse mem­bers of the team pro­vide real in­sight into pa­tients’ day-to-day ex­pe­ri­ences by virtue of hav­ing the great­est de­gree of con­tact with them and their fam­i­lies.

What re­sults have the teams seen? As Mary Hoosh­mand, re­gional nurs­ing di­rec­tor for the Florida Depart­ment of Health, notes, the pro­gram achieves strong per­for­mance mea­sure­ments on the Health­care Ef­fec­tive­ness Data and In­for­ma­tion Set and is a top-ranked provider de­spite the dif­fi­cult cases it han­dles.

These ef­forts rep­re­sent a strong start, but the road is long. As it is at Chil­dren’s Med­i­cal Ser­vices, health­care should al­ways be a highly col­lab­o­ra­tive en­ter­prise. To de­liver the best care, each pro­fes­sion should per­form its re­spec­tive job at the high­est level and in con­cert with oth­ers. The fu­ture of Amer­ica’s health­care sys­tem clearly lies in even greater lev­els of team­work as we look to more cost-ef­fec­tive mod­els of care across set­tings. It is time to leave our si­los and our com­fort zones be­hind.

The time to find a com­mon pur­pose is now. Mak­ing our health­care sys­tem bet­ter must be our ral­ly­ing point. The chal­lenge is sub­stan­tial but the re­ward is great. Af­ter all, pro­vid­ing the very best care for each of our pa­tients speaks to the very rea­son we chose our pro­fes­sion.

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